Webinar Monday, Jan. 11, will focus on stopping use of electronic cigarettes and other substances by Kentucky's young people

The webinar is free but registration is required. Register here: https://bit.lu/2FgenhY

Substance use among young people is a persistent problem in Kentucky, according to the 2019 Youth Risk Behavior Survey. One in four students in high school, where most adult tobacco users got their start, say they have used electronic cigarettes -- and that rate rose dramatically as 2019 went along.

High-school students' use of alcohol, which had declined for more than two decades, plateaued at 23 percent in 2019. About 15 percent of high schoolers used marijuana, and 11 percent abused prescription painkillers. Other illicit drug use is less common among high schoolers, but a rising number (23 percent in 2019) are being offered illegal drugs on campus, says the Foundation for a Healthy Kentucky.

"These statistics are alarming, but there are proven policies and programs to help reduce tobacco and other substance use during youth," the foundation says in announcing a free one-hour webinar to share solutions at 2 p.m. ET Monday, Jan. 11. The webinar will conclude the foundation's annual Howard L. Bost Memorial Health Policy Forum series, which focused this year on improving child health in Kentucky, in partnership with Kentucky Youth Advocates. 

The panelists on the webinar, "Stopping Vaping and Substance Use," will be:

• Van Ingram, executive director, state Office of Drug Control Policy
• Tami Cappelletti, programs and education manager, American Lung Association, "How to Talk to Your Kids About Vaping"
• Devine Carama, Lexington FEND (Full Energy, No Drugs) Movement
• Abby Hefner, anti-vaping advocate, McCracken County High School

The discussion will be moderated by Eva Stone, health coordinator for Jefferson County Public Schools. Speakers will help participants:

• Understand the current state of youth use of tobacco, alcohol, and other substances, as well as both longer-term trends and the specific impact of the Covid-19 pandemic on those trends. 
• Explore evidence-based programs regarding how to talk to youth about e-cigarettes and vaping.
• Learn about an effective youth substance-use prevention program in Lexington.
• Hear about a McCracken County youth's experience of becoming addicted to nicotine, how she finally quit vaping, and her subsequent advocacy work.

Legislators, educators, advocates and others who want to learn more about evidence-based policies and programs to reduce youth tobacco and other substance use are encouraged to attend. The webinar is free, but registration is required: Register here.

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Omnibus relief bill includes ban on mail sales of e-cigarette products; FedEx will not handle shipments after March 1

The catch-all bill to keep the government open, provide pandemic relief and do many other things includes a ban on mail shipments of electronic-cigarette products, and apply federal laws on cigarette sales to online sellers of e-cigarette products.

The bill becomes law March 27 and gives the U.S. Postal Service until April 26 to impose regulations implementing it.

"With the USPS off limits for online sellers, private delivery services will immediately be pressured by anti-tobacco (and -vaping) groups to prohibit shipping of vaping products," reports Vaping360, a site that promotes the practice as an alternative to traditional cigarettes."

FedEx has announced it will stop handing e-cigarette products March 1, Vaping360 reports.

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Positive-test rate jumps above 9% on seventh highest day of new coronavirus cases; 29 more deaths; state auditor tests positive

By Al Cross

Kentucky Health News

All major measures of the pandemic increased in Kentucky Wednesday, most notably the percentage of Kentuckians testing positive in the last seven days for the novel coronavirus.

That figure jumped to 9.09%, more than a full percentage point above Monday's seven-day average and the highest since Dec. 10.

A release from Gov. Andy Beshear's office paraphrased him as saying that the rise may have been causes by holiday closures of some testing sites and labs, "increasing the percentage of tests conducted in medical settings where patients are already experiencing symptoms and suspect they may have the virus."

The release's direct quote from Beshear was, “Our report for today is higher than it has been for a number of days. The progress we have made is fragile. We have to keep working and making good decisions every day. We need everybody to be safe this New Year’s Eve. Do not gather in large groups.”

The state reported 3,784 new cases of the virus, the seventh largest one-day figure. That raised the seven-day rolling average for the first time in eight days, to 2,150, about what it was on Saturday, Dec. 26.

Beshear reported 29 more deaths attributed to Covid-19, raising the seven-day average of deaths to 22.4 and the 14-day average to 25.8. The total is 2,623.

Kentucky hospitalizations for Covid-19 also increased, to 1,673, with 433 of those patients in intensive-care units (14% higher than Tuesday) and 234 ICU patients on ventilators (11% higher than Tuesday).

A third hospital region, Barren River, jumped well above 80% ICU capacity, the threshold for concern. The state's daily report said 86.1% of the region's ICU beds are occupied. The most critical region is Lake Cumberland, at 95.6%. The easternmost region, from Lee County to Pike County, is at 85.3%.

Auditor infected: State Auditor Mike Harmon announced that he and wife tested positive for the virus, have mild symptoms, and are isolating. He said she was tested Tuesday morning after learning that she might have been exposed to the virus, and when her test was positive, he got tested, too.

Auditor Mike Harmon

Harmon, 54, was among the latest round of state officials who got the vaccine Monday, but vaccines usually take a week or two to gain full effect, and both of the coronavirus vaccines in use require a follow-up booster shot three to four weeks after the first dose to be considered fully effective.

Harmon said, “While the timing of my positive test comes one day after receiving the Covid-19 vaccine, I still have full faith in the vaccine itself, and the need for as many people to receive it as quickly as possible.”

At least one of Harmon's fellow constitutional officers turned down Democratic Gov. Andy Beshear's invitation to get the vaccine. Agriculture Commissioner Ryan Quarles, who like Harmon is a term-limited Republican interested in unseating Beshear in the 2023 election, issued this statement:

"I plan on taking the vaccine, but I will wait for my turn in line. Though I appreciate the governor’s invitation, as a healthy 37-year old man with no underlying conditions I would rather my early access vaccine be given to a high-risk individual like a frontline worker or a resident of a long-term care facility, two groups who have unfortunately borne the brunt of the coronavirus. I understand the Centers for Disease Control’s recommendation that officials like the governor and top legislators be vaccinated for the sake of government continuity, but I do not believe rank-and-file politicians should be leapfrogging over those who are at higher risk of infection."

In other coronavirus news Wednesday:

• The 29 newly confirmed Covid-19 fatalities were two women, 63 and 75, and an 81-year-old man from Bath County; a Bell County woman, 67; a woman, 96, and a man, 82, from Boone County; a Campbell County man, 86; three women, 80, 88 and 91, and two men, 70 and 84, from Fayette County; two women, 69 and 73, and two men, 68 and 82, from Floyd County; a Hopkins County man, 96; five Jefferson County women, 54, 71, 85, 100 and 100; a Johnson County woman, 78; a Kenton County man, 88; a Lawrence County woman, 79; a Lewis County woman, 82; a Mason County man, 67; a Monroe County woman, 93; and a Perry County man, 90.
• Counties with more than 10 new cases were: Jefferson, 527; Fayette, 259; Kenton, 141; Hardin, 125; Pulaski, 104; Christian. 101; Laurel, 99; Boone, 97; Warren, 96; Daviess, 91; Boyle, 87; Pike, 75; Oldham, 74; Bullitt, 65; Clay, 57; Greenup, 57; Boyd, 55; Bourbon, 50; Campbell, Hopkins and Whitley, 48; Bell, 41; McCracken, 40; Madison, 38; Graves, 34; Harlan, 33; Knox and Nelson, 32; Fleming, 31; Marshall, Meade, Montgomery and Muhlenberg, 29; Carter, Franklin and Jessamine, 28; Allen, Clinton and Taylor, 27; Calloway, Lawrence and Mason, 26; Henderson and Shelby, 25; Anderson and Scott, 24; Floyd, Grayson, Lincoln and Wayne, 23; Breckinridge and Woodford, 22; Clark, 21; Butler, Johnson, Perry, Rockcastle, Rowan and Todd, 18; Logan and Ohio, 17; Barren, Hancock and LaRue, 15; Breathitt, Garrard, Russell and Webster, 14; Henry, Knott, Lewis, Mercer, Simpson and Spencer, 13; Carroll, Hart, Jackson, McCreary and Monroe, 12; and Metcalfe, 11.
• Senate Majority Leader Mitch McConnell announced that President Trump's demand for additional relief checks to Americans "has no realistic path to quickly pass the Senate." He cited the national debt and the lack of targeting: "It is hardly clear that the federal government’s top priority should be sending thousands of dollars to, for example, a childless couple making well into six figures who have been comfortably teleworking all year." He concluded, “The Senate is not going to be bullied into rushing out more borrowed money into the hands of the Democrats’ rich friends who don’t need the help. We just approved almost a trillion dollars in aid a few days ago. It struck a balance between broad support for all kinds of households and a lot more targeted relief for those who need help most."
• "The virus does not seem to spread much within schools when they require masks, urge social distancing, have good ventilation and when community spread is low," The Washington Post reports, summarizing the latest research. "But because of a lack of a cohesive federal response, huge gaps in the data remain, and many say new information about school transmission is not sufficient to make far-reaching conclusions."

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Beshear worries that New Year's on top of Christmas will reverse Kentucky's recent progress on thwarting the novel coronavirus

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Pandemic thrusts Health Commissioner Steven Stack from usually low-profile job into often harsh spotlight of public scrutiny

State Health Commissioner Steven Stack, M.D., made a point during a news conference as Gov. Andy Beshear listened. (Photo by Matt Stone, Louisville Courier Journal) 

Less than a month after Dr. Steven Stack moved from running a hospital emergency department to running the state Department for Public Health, the first case of the novel coronavirus was reported in Kentucky and he immediately became the point person for handling it.

"I had no idea I was signing up for this," Stack told Deborah Yetter of the Louisville Courier Journal. "There was no way to anticipate this once-in-a-century pandemic, the likes of which no one alive has had to confront."

Yetter writes that the pandemic also thrust Stack from a job that "tended to be occupied by low-profile bureaucrats . . into the glare of public scrutiny," to which he wasn't accustomed, though he had been president of the American Medical Association in 2015.

"I didn't expect to be a TV personality," Stack told a legislative committee in August, Yetter notes. "I expect most governors forget their public-health commissioner once they announce the appointment."

Stack, 48, "said he has no regrets about taking on the job that has come with grueling hours and political firestorms over restrictions the state imposes, often on his advice, to try to limit the spread of Covid-19," Yetter reports.

"Yes, I would do it again," Stack said. "How many times do each of us have an opportunity in our lives to have such a meaningful impact?"

Stack was the second youngest president of the AMA and brought an unusual background to his medical and governmental career.

"Bespectacled and scholarly, partial to bow ties, Stack looks and speaks like the classics major he was at College of the Holy Cross, a Jesuit liberal arts school in Massachusetts he attended after attending St. Ignatius High in Cleveland, Ohio, also a Jesuit school," writes Yetter, a fellow Catholic.

"Holy Cross is the same college attended by the nation's top public infectious diseases expert, Dr. Anthony Fauci, 79 — though several decades apart, Stack once noted at a news conference. Stack often mentions his undergraduate studies, which included Greek, Latin and history as good preparation for the political heat he sometimes encounters as he seeks to convince a skeptical public and politicians about steps to curb the spread of Covid-19."

Stack asked, "Am I surprised by the by the intensity of the feelings expressed and the accusatory nature in which it is sometimes communicated? That's well-established throughout history. That's not new."

The strongest criticism of Stack has come from Republicans who control the General Assembly and are poised to cut back Beshear's emergency powers in the legislative session that begins Tuesday, Jan. 5.

At legislative committee meetings, Stack has been the lightning rod for criticism of Beshear's pandemic restrictions, on which he has advised, and more directly on his lack of responsiveness to emails and phone calls from legislators and the state's use of data that measures the pandemic.

When a deputy acknowledged at an August meeting that the reported positivity rate -- the percentage of Kentuckians testing positive for the virus in the previous seven days -- was imperfect because negative tests don't have to be reported, Sen. Danny Carroll, R-Paducah called the rate "totally inaccurate."

 
Stack replied that while the number is not perfect, does show trends, and is just one data point on which decisions are made. A few weeks later, the state started basing the rate only on electronically reported test results, and it did not appear to make a significant difference in the percentage.

Yetter's story ends with a statement Stack made to the committee: "I'm not here trying to save everybody. I can't save everyone. We're all dying, just some a little more quickly than others. I'm not here to separate people from their deaths, but I do want to prevent it from happening on a mass scale in people who should not have to or would not have to die."

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Beshear says people 70 and older will be in next phase of vaccinations; he faces major task in deciding who will come next

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Legislation to fix surprise medical billing won't apply to ground ambulances, but may produce data that will spur their inclusion

The new law will apply to air ambulances of Lifeguard Emergency Services of Eastern Kentucky and those of other U.S. ambulance services, but not to their ground ambulances. (Lifeguard photo)

The congressional fix for surprise medical bills, contained in the legislation to keep the government open, provide pandemic relief and do many other things, does not apply to ground ambulances, which "have the highest out-of-network billing rate of any medical specialty," The New York Times reports.

Congress "had little data on the actual costs of ambulance trips, and worried about tussling with the local governments that often oversee these services — especially those whose budgets have been battered by the economic downturn," Sarah Kliff and Margot Sanger-Katz report for the Times.

Research by Dr. Karan Chhabra of Boston's Brigham and Women’s Hospital found 71 percent of ambulance rides "have the potential to generate a surprise bill, with an average cost to the patient of $450," the Times reports. "Whether an ambulance company chooses to pursue this bill is something his research cannot determine, which is why it is merely potential." An earlier study found most ambulance rides "resulted in an out-of-network bill, a substantially higher rate than the medical specialties that the new legislation covers."

In the world of surprise medical bills, $450 is relatively small, and many ambulance services write off unpaid out-of-network bills as bad debts. But the new Congress could extend the new law — which President Trump signed Sunday night and will take effect in 2022 — to include ground ambulances.

"Medicare, which pays ambulances set rates and bans surprise billing for the patients it covers, is reviewing its payment rates," the Times reports. "As part of that process, the government is collecting detailed data from ambulance companies about their costs and prices. And the surprise-billing legislation passed this week establishes a commission to study the problem of ground ambulance bills, another way for lawmakers to learn more about how things are currently working."

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Beshear's Facebook post shows generally stable numbers; comments on it reveal support, skepticism and unhappiness

Ky. Health News graph; click it to enlarge. New cases reflect unadjusted initial daily reports.

By Al Cross
Kentucky Health News

Metrics of the novel-coronavirus pandemic remained generally stable Sunday, as Gov. Andy Beshear made only a Facebook post giving the numbers.

The state reported 1,509 new cases, marking the fifth consecutive Sunday that the number has been lower than the previous Sunday. Reporting on Sundays and Mondays is limited due to less testing and lab work on weekends; on top of that, this is the end of a four-day holiday weekend for most people.

The share of Kentuckians testing positive for the virus in the past seven days was 8.06 percent, the average of the last four days.

The number of Covid-19 patients in Kentucky hospitals continued to decline, to 1,504, the lowest total since 1,442 on Nov. 16. Intensive-care units had 411 of those patients, about the average of the last 10 days. ICU patients on ventilators totaled 217, about the average of the last five days.

The state attributed the deaths of 21 more people to Covid-19, but did not publish the usual list of deaths by gender, age and county.

Counties with 10 or more new cases were: Jefferson, 169; Fayette, 101; Henderson, 64; Boone, 63; Daviess, 60; Kenton, 56; Hardin, 43; Bullitt, 41; Calloway, 40; McCracken, 37; Pulaski, 36; Boyd, 34; Warren, 34; Boyle, 32; Letcher, 32; Campbell, Henry  an Lincoln, 25; Shelby, 23; Nelson, 22; Christian and Wayne, 21; Graves and McCreary, 20; Breathitt, 18; Madison, 17; Franklin, 16; Carter, 15; Grayson, 14; Scott, 13; Meade and Taylor, 12; Elliott, Floyd and Oldham, 11; and Clark and Union, 10. 

African Americans' share of Kentucky coronavirus cases and Covid-19 deaths continue to decline. The state's latest daily report says 9.5% of cases and 9.8% of deaths are among Blacks, who are about 8.5% of the state's population.

Not-always-social media: Beshear's Facebook post at around 3 p.m. generated more than 400 comments by 5 p.m. Most were favorable, but some reflected skepticism and unhappiness.

"I guess these fake numbers will get better every day until inauguration day," one man wrote, prompting several replies, such as "Yeah, just like it was gonna disappear after Election Day!" and "What a heartless thing to say. People are losing loved ones. I hope you don’t have to experience that to start believing it."

To the numbers of cases, the sick and the dead, one man replied, "Great, now what about unemployment? That’s just as important as these numbers are."

Many defended Beshear. One said, "Some people refuse to listen and they have caused the senseless deaths of others."

That brought this reply: "Just as the governor did not cause unemployment, permanent shuttering of small businesses, and collateral damage to students through online education, the people who refused to listen did not cause 'the senseless deaths of others.' The pandemic virus caused each. Playing the blame game helps no one." And that brought this rejoinder: "Those not doing what it takes to slow transmission of the virus are most definitely to blame for the deaths."

In other coronavirus news Sunday:

• The smaller-than-expected initial supplies of vaccines are nothing unusual and should not keep most Americans from being able to get the vaccine by late April, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN's :State of the Union: "I believe we'll catch up with the projection."

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Trump helped get vaccines produced quickly, but he and some of his allies are complicating efforts to get people to take them

Trump and Dr. Anthony Fauci listened as Dr. Deborah Birx, response coordinator of the White House Coronavirus Task Force, spoke several months ago. (Photo by Bill O'Leary, The Washington Post)

"President Trump and his allies have spent years stoking disinformation and doubt in official accounts about the election, the coronavirus, and other topics. Now those efforts are making it harder to rally support around his administration’s vaccine push," report Elizabeth Dwoskin and Josh Dawsey of The Washington Post.

The phenomenon has implications for Kentucky, because Trump carried the state by large margins: 29.8 percentage points in 2016 and 25.9 points in 2020. Though he lost, he has a large following and media allies.

The president "has hailed his administration’s investments in vaccine development," but he "has a history of questioning vaccines" and has not committed to taking a vaccine, and misinformation experts told the Post that his "messaging that people should distrust authority has made it harder for the administration to take a victory lap over vaccine development," the Post reports.

White House spokesman Brian Morgenstern said, “President Trump has repeatedly referred to the vaccines as ‘miracles’ and encouraged the American people to take them — including when he hosted an hours-long, live-streamed and nationally televised summit to educate the American people about the vaccine development and distribution process, build confidence in the safety and efficacy of the vaccines, and commemorate their creation as a national achievement that will save millions of lives.”

But Trump is only part of the puzzle, Dwoskin and Dawsey report: "Conspiracy theories about the vaccine are also brewing within Trump’s base, particularly among evangelical Christians and followers of the QAnon conspiracy theory, according to a report by the misinformation research group Zignal Labs."

The group "found that the most popular misleading story line about the coronavirus vaccine in recent weeks was about people who took the Pfizer vaccine developing the disease Bell’s palsy, which temporarily paralyzes muscles in the face," the Post reports. "An article from the Daily Mail, which reported that four volunteers who took the vaccine then developed the disease, garnered more than 179,000 shares on Facebook and 12,000 shares on Twitter, with an evangelical Christian community on Facebook contributing the single largest number of shares."

PolitiFact, a service of the Tampa Bay Times, says social-media users have exaggerated and distorted the story. "While the original Daily Mail story was accurate, and therefore allowed by the social-media companies, scientists have said that the number of people who developed Bell’s palsy — 4 in a group of 22,000 — is consistent with the number of people who have the disease in the actual population, and may have nothing to do with the vaccine, the fact-checking group said. The FDA is monitoring the issue," the Post reports. "At the same time, a popular Facebook meme appearing to depict the volunteers was actually recycling a photo from 2019."

Social-media chatter may be filling a vacuum left by Trump, who "has been somewhat absent from the conversation, frustrating aides who say that he could have a major impact on drumming up support for vaccination, say people familiar with the discussions who spoke on the condition of anonymity to discuss sensitive matters freely," Dowskin and Dawsey write.

"With so many Americans expressing doubt about the vaccine, aides say Trump could convince tens of millions of Americans — his most fervent supporters — that it was safe if he took it himself, the people said. But so far, he has not publicly announced plans to do so and has not held any major event to promote it. He has tweeted praising the vaccine, but he has eschewed any public appearances since its release to either take it or laud it, instead spending much of his time in meetings and on phone calls about overturning the election, aides said."

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State reports Christmas Eve was pandemic's second-deadliest day, with 53 Covid-19 deaths, but positive-test rate fell below 8%

Screenshot of adapted New York Times interactive map shows Kentucky better than adjoining states but with hotspots like Clinton and Clay counties, with 102 and 101 cases per 100,000, respectively.

By Al Cross
Kentucky Health News

Christmas Eve was Kentucky's second-deadliest day of the pandemic, with confirmation of 53 deaths from Covid-19, Gov. Andy Beshear announced Saturday in a three-day report, his first since before the two state holidays.

Eleven deaths were confirmed Friday and four Saturday. The 53 deaths reported Thursday were second only to the 54 confirmed on Dec. 17.

“The number of deaths we’re announcing today is truly heartbreaking – another wake-up call,” Beshear said in a press release. “But one piece of good news is that our positivity rate continues to decline. It was even under 8 percent on Christmas Day.”

Kentucky Health News graph; click on it to enlarge

On Friday, the share of Kentuckians testing positive for the coronavirus in the last seven days was 7.95%. It was 8.2% Thursday and 8.04% Saturday. (The rate had been above 8% since Nov. 11 and peaked at 10.07% Dec. 3.)

“That means our sacrifices are making a difference,” Beshear said. “Thank you for doing the holidays differently this year to protect each other. Let’s keep working hard so we don’t have more days like today where we have to announce we’ve lost so many of our neighbors, family and friends.”

Probably due to limited testing-laboratory activity and reporting, reported numbers of new cases declined over the period, from 2,742 Thursday to 1,803 Friday to 764 Saturday.

The pattern resembled the one at Thanksgiving, when the day after the holiday had fewer than half the cases reported on the holiday. The periods are not fully comparable, since many people and laboratories take holidays on the day after Thanksgiving but the day before Christmas.

The seven-day rolling average of daily new cases fell to 2,725 Thursday, 2,528 Friday and 2.153 Saturday, the lowest since Nov. 13.

Kentucky hospitals reported 1,689 Covid-19 cases Thursday, 1,601 Friday and 1,511 Saturday, the  fewest since Nov. 16. However, Covid-19 patients on ventilators jumped to 237 on Saturday, the most in a week.

Health officials fear another surge in cases as a result of contacts during the holidays, but Health Commissioner Steven Stack sounded a positive tone.

“Many Kentuckians found new ways to celebrate Christmas yesterday, including limiting their in-person interactions with others,” Stack said in the news release. “Your sacrifices are appreciated, and a gift of kindness to your loved ones and your neighbors, as we keep this dreadful disease from spreading more rapidly. Please make sure you’re familiar with symptoms of this virus, and if you aren’t feeling well, please stay home until you are better or see a health-care provider.”

The 53 Covid-19 deaths confirmed Thursday included six from Hopkins County – four women, aged 67, 74, 92 and 94, and two men, 74 and 77 – and five from Pulaski County: three women, 52, 87 and 90; and two men, and 91. Each county also had a Covid-19 death on Friday.

The other deaths Thursday were a 67-year-old man from Boyle County; a 72-year-old Breckinridge County woman; two Bullitt County men, 55 and 74; a Campbell County man, 77; two women, 90 and 91, and man, 89, from Christian County; a Cumberland County woman, 71; two Daviess County men, 63 and 65; a Floyd County woman, 82; a Franklin County man, 83; a Graves County woman, 84; a woman, 94, and a man, 87, from Grayson County; a Hardin County woman, 100; a woman, 85, and three men, 70, 80 and 90, from Jefferson County; two Jessamine County men, 74 and 89; three Madison County women, 64, 68 and 73; a Mason County woman, 69; two Monroe County men, 73 and 77; two Muhlenberg County women, 77 and 90; an Ohio County woman, 77; an Owen County man, 91; a Rockcastle County woman, 66; three Russell County women, 86, 87 and 90; two Taylor County women, 82 and 84; a Trigg County man, 86; a Warren County man, 73; and a Wolfe County woman, 75. 

Friday's fatalities were an Anderson County man, 84; a Barren County woman, 71; a Cumberland County man, 60; a Franklin County woman, 71; a Hopkins County woman, 71; a Logan County woman, 87; a Madison County woman, 81; two McCracken County men, 62 and 91; a Monroe County man, 58; and Pulaski County woman, 85. Saturday's were a Hart County woman, 71; a Jefferson County man, 99; a Monroe County woman, 94; and a Simpson County man, 76.

In other coronavirus news:

• Counties with 10 or more new cases Thursday were: Jefferson, 377; Warren, 150; Fayette, 147; Daviess, 97; Kenton, 90; Boyle, 77; Boone, 76; Marshall, 60; Boyd, 59; Christian, 59; Campbell, 55; Pulaski, 52; Muhlenberg, 44; Hardin, 42; Laurel, 40; Hopkins, Anderson, 34; Knox, 33; Lawrence, 33; Madison, 32; Bullitt, 31; Oldham, 31; Graves, 30; Harlan, 30; Calloway, 29; McCracken, 29; Nelson, 28; Wayne, 27; Floyd, 26; Grant, 26; Henderson, 25; Logan, Shelby and Simpson, 24; Letcher, 23; Greenup, 22; Carlisle, 21; Clark, Scott and Whitley, 20; Jessamine, 19; Allen, Estill, Lincoln and Pike, 17; Bourbon, 16; Fleming, Ohio, Rowan and Washington, 15; Lewis and Meade, 14; Jackson, Montgomery and Perry, 13; Barren, Clinton, Lyon, Mercer and Rockcastle, 12; Carter and Union, 11; and Bell, Clay, Livingston, Marion, Martin, Taylor and Woodford, 10.
• Counties with 10 or more new cases Friday were: Jefferson, 428; Fayette, 177; Kenton, 89; Laurel, 51; Madison, 49; Christian, 42; Boyle, 41; Clay, 41; Boone, 40; Greenup, 39; Warren, 39; Graves, 29; Oldham, 29; Campbell, 28; Daviess, 28; McCracken, 27; Hardin, Letcher and Lincoln, 25; Pike, 24; Jessamine and Mercer, 21; Mason, 18; Harlan, 17; Bullitt, 16; Bell and Franklin, 15; Wayne, 14; Carter and Grayson, 13; Anderson, Fleming and Floyd, 12; and Allen, Calloway, Muhlenberg and Powell, 11.
• Counties with 10 or more new cases Saturday were: Jefferson, 228; Fayette, 97; Warren, 29; Kenton, 27; Boone, 24; Fleming, 17; Franklin, 15; Campbell, 14; Greenup, 12; Madison, 12; Hopkins, 11; Logan, 10; and Whitley, 10.
• "Scientists initially estimated that 60% to 70% of the population needed to acquire resistance to the coronavirus to banish it. Now Dr. Anthony Fauci and others are quietly shifting that number upward," reports Donald McNeil of The New York Times. “We really don’t know what the real number is,” Fauci told McNeil. But McNeil writes, "Having a good estimate is important. It gives Americans a sense of when we can hope to breathe freely again. . . . In the pandemic’s early days, Fauci tended to cite the same 60 to 70 percent estimate that most experts did. About a month ago, he began saying '70, 75 percent' in television interviews. And last week, in an interview with CNBC, he said '75, 80, 85 percent' and '75 to 80-plus percent.' . . . Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks. Hard as it may be to hear, he said, he believes that it may take close to 90 percent immunity to bring the virus to a halt — almost as much as is needed to stop a measles outbreak. Asked about Fauci’s conclusions, prominent epidemiologists said that he might be proven right."
• The Centers for Disease Control and Prevention took 46 days to produce a working test for the coronavirus; scientists in Thailand did it in hours. The Washington Post explains what went wrong: "An overly ambitious test design and laboratory contamination . . . CDC leaders underestimated the threat posed by the new virus, and overestimated the agency’s ability to design and rapidly manufacture a test. Quality-control measures failed to prevent the shipping of compromised kits to dozens of state and local public health labs. . . . Without tests to identify the early cases, health authorities nationwide were unable to isolate the infected and trace the rapid spread among their close contacts. Those who were asymptomatic, yet contagious, went undetected. CDC Director Robert Redfield, an appointee of President Trump, took a hands-off approach while the in-house manufacturing efforts foundered and agency scientists clashed over whether to alter the design of the problem-plagued test, according to CDC and other federal officials."

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As state heads into a long holiday weekend, new-case average keeps ticking up but Beshear emphasizes recent successes

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

By Al Cross
Kentucky Health News

Kentucky's averages of recent coronavirus cases and deaths continued to increase slightly Wednesday, but the percentage of Kentuckians testing positive for the virus continued to decline, and Gov. Andy Beshear remained upbeat as he issued his last pandemic report until after Christmas.

“This war is far from over, but we’ve won another battle, beating back exponential growth of this virus in our state before Christmas,” Beshear said in a press release.

“I hope you all enjoy a wonderful holiday, even if it looks a little different this year. Please be careful so we can hold on to the progress we’ve made. What I love about this holiday most is that it’s not about the gifts; it’s about people taking care of each other and appreciating their loved ones and community more than ever. Let’s all live up to the true spirit of Christmas this year, and every year in the future after we get through this together.”

The state reported 2,953 new virus cases Wednesday, raising the state's seven-day rolling average of daily new cases to 2,811. That was the third daily increase in a row; it was 2,761 on Dec. 20.

Beshear reported 26 more deaths from Covid-19, raising the state's toll to 2,466 and pushing the seven- and 14-day averages of deaths to 29.1 and 24.9, respectively.

Deaths are a lagging indicator. A leading indicator, the percentage of of Kentuckians testing positive for the virus in the last seven days, declined again, to 8.35%. That is the lowest rate since Nov. 12.

"Through the leadership of the governor, public-health officials, and Kentuckians adapting safe behaviors, virus level continue to decrease," said the latest White House Coronavirus Task Force report on Kentucky, for Dec. 12-18.

The report said "Hospitals are reporting critical staffing shortages, but the state is managing."

Wednesday's case numbers from Kentucky hospitals were generally stable. They reported 1,644 Covid-19 cases, 413 of them in intensive care and 222 of those on ventilators.

Coleman shows her shot site.

More state officials were vaccinated Wednesday: Lt. Gov. Jacqueline Coleman, Chief Judge Denise G. Clayton of the Kentucky Court of Appeals, acting State Police Commissioner Phillip Burnett Jr., Emergency Management Director Michael Dossett. Beshear Chief of Staff La Tasha Buckner, Senior Adviser Rocky Adkins and Virginia Moore, executive director of the Commission on the Deaf and Hard of Hearing, the lead sign-language interpreter at Beshear's briefings.

Beshear and other top-ranking officials were vaccinated Tuesday. He 
said Health Commissioner Steven Stack urged top officials to be vaccinated for the continuity of state government and to demonstrate to Kentuckians that the vaccine is safe and effective. The latter reason was cited by the director of the Centers for Disease Control and Prevention in requesting governors to be publicly vaccinated as soon as possible.

The 26 fatalities announced Wednesday were a 95-year-old woman and a 77-year-old man from Adair County; a Allen County man, 82; a woman, 90, and a man, 69, from Bath County; a Carter County man, 85; a Casey County man, 85; a Clinton County woman, 87; a Daviess County woman, 89; two Fayette County women, 85 and 89; a Greenup County man, 69; two Harlan County men, 73 and 89; a Hopkins County woman, 85; a woman, 82, and two men, 66 and 90, from Jefferson County; a Letcher County man, 69; two Lincoln County women, 69 and 79; a Madison County man, 83; a Mason County woman, 90; and from Pulaski County, a man, 76, and two women, 62 and 63.

In other coronavirus news:

• Counties with more than 10 new cases were: Jefferson, 415; Fayette, Kenton, 124; Daviess, 103; Boyle, 98; Warren, 80; Boone, 77; Pike, 77; Laurel, 73; Hardin, 72; Christian, 68; Whitley, 60; Pulaski, 54; Wayne, 53; Lincoln, 50; McCracken, 47; Graves, 46; Madison, 45; Hopkins, 43; Oldham, 41; Harlan, 40; Bullitt, 38; Shelby, 36; Clay, 34; Marshall, 33; Henderson, 31; Anderson, 30; Marion, 28; Scott, 28; Campbell, 26; Taylor, 26; Barren, 24; Johnson, 24; Greenup, 23; Calloway, 22; Clinton, 21; Bath, Clark, Floyd, Franklin and Mercer, 20; Fleming, 19; Allen and McCreary, 18; Carter, Grayson, Jessamine and Todd, 17; Bell, Knox and Nelson, 16; Bourbon and Grant, 15; Rowan, 14; Breathitt, McLean, Rockcastle and Woodford, 13; Lawrence, 12; and Lewis, Martin and Union, 11.
• State Auditor Mike Harmon says the state doesn't know how much money it owes people for backlogged unemployment benefits, the Lexington Herald-Leader reports.

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As virus cases, hospitalizations and deaths tick back up, Beshear says holiday actions may determine who's around for next year's

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Governor, legislative leaders, chief justice, cabinet secretary, health commissioner, first lady get vaccinated in Capitol rotunda

First lady Britainy Beshear watches as nurse Michelle Searcy
of the Franklin County Health Department gives the governor
a dose of the Moderna vaccine. (Governor's office photos)

By Al Cross
Kentucky Health News

Gov. Andy Beshear, first lady Britainy Beshear, state Senate President Robert Stivers, House Speaker David Osborne, Health Commissioner Steven Stack and other officials took vaccinations for the novel coronavirus in the rotunda of the state Capitol this morning.

The event showed "broad, bipartisan support for the safe, effective Covid-19 vaccination," a news release from Beshear's office said. It said the Beshears' two children, aged 11 and 10, will be vaccinated when a vaccine is approved for children.

“I would not risk my life or the life of my family, which I love more than life itself, if I didn’t believe this vaccine was safe and highly effective,” Beshear said. “These vaccines are a gift and our best vehicle to end this evil pandemic, allow our children and educators to safely return to school and reignite our economy.”

Senate President Robert Stivers gets his vaccination.

The event was an unusual joint effort for the Democratic governor and the leaders of the legislature's heavy Republican majorities, who have criticized his approach to the pandemic and have vowed to limit his emergency powers -- but recently got a briefing, courtesy of Beshear, from the response coordinator of the White House Coronavirus Task Force.

In the news release issued by Beshear's office, Stivers said, “The arrival of the Covid-19 vaccine signals an optimistic turning point in our fight against the virus. This bipartisan group of leaders chose to take the vaccine together to send a message that the vaccine is safe and it is crucial for the health and welfare of the commonwealth. The importance of taking the vaccine cannot be overstated, because you are protecting yourself and your fellow Kentuckians. I encourage everyone who is able to get vaccinated when the opportunity arises.”

House Speaker David Osborne gets his vaccination.

Osborne said in the release, “As health care workers and medical providers line up to receive theirs, Kentuckians should begin talking to their physicians about their plans to take the vaccine. We are here today because as leaders of all three branches of state government, we know there are those who question whether or not the vaccine is right for them. While it is a personal choice, we have full faith in its safety and supportive of the state’s work to make it available.” 

Chief Justice John Minton gets his vaccination.

Minton said, “I appreciate the governor’s request for the heads of the three branches of government to be vaccinated. I recognize this is a privilege most Americans don’t yet have, but Dr. Steven Stack and the Centers for Disease Control recommended that we get the vaccine to ensure the continuity of state government. I’ve already begun advocating for our judges, circuit clerks and deputy clerks to get the vaccine as soon as they’re eligible based on the federal distribution schedule. They’re essential workers who have frequent contact with the public and we want to ensure their safety as they conduct the important business of the courts.”

Secretary J.M. Brown gets his vaccination.

Also vaccinated in the rotunda was J. Michel Brown, secretary of the Executive Cabinet, the office that oversees the executive branch of state government, and Stack, who has been the state's point person for dealing with the pandemic. “I’m grateful that the senior leaders of Kentucky’s government have come together today for a shot of hope and to lead through their example,” Stack said. “These vaccines offer new hope just in time for the holidays that 2021 will bring healthier, happier times.”

Beshear encouraged other elected officials and community leaders, including business executives and faith leaders, to get vaccinated when it is their turn. 

 

In other coronavirus news Tuesday:

• The pandemic relief and government funding bill includes several provisions for rural health care including a reform of Medicare’s payment formula for rural health clinics, Inside Health Policy reports: "The package ensures no Rural Health Clinic has its reimbursements reduced while phasing in over eight years a steady increase in the Rural Health Clinic statutory cap. All new clinics will be subject to a uniform per-visit cap, and uncapped clinics with payments above the upper limit will have their annual rate of growth controlled."

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Beshear says people 75 and older have 'compelling argument' to get vaccine after nursing homes and health-care workers

By Al Cross
Kentucky Health News

Kentuckians 75 and older have a "very compelling argument" to be among those next in line to get coronavirus vaccines, Gov. Andy Beshear said Monday as vaccinations began at nursing homes in the state.

Last week, Beshear said that after nursing-home workers, staff and other health-care workers, the next group would be first responders and K-12 educators. Sunday, a Centers for Disease Control and Prevention advisory committee said the next group should also include people 75 and older, as well as workers key to the function of society, including teachers, police officers, firefighters, corrections officers and grocery workers.

Beshear said he is "actively considering" adding people over 74 to the next group because the CDC "makes a very compelling argument," and in Kentucky, "our mortality rates are more attached to age" than in most other states.

More than 1,600 residents of Kentucky long-term-care facilities -- skilled-care nursing homes, personal-care homes and assisted-living facilities -- have died of Covid-19, two-thirds of the state's overall total.

Because they are "by far the most vulnerable population that Covid-19 preys upon," Beshear said as he announced that Walgreens and CVS began vaccinating nursing-home residents early Monday morning.

The mortality rate is so high, Beshear said, that the vaccine "will save lives, beginning today."

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Kentucky shows little improvement in America's Health Rankings; we're getting less exercise, and diabetes has increased

America's Health Rankings chart, relabeled by Kentucky Health News; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

Kentucky again ranks near the bottom in two big health measures: 48th for health behaviors and 46th for health outcomes, according to the America's Health Rankings report from the United Health Foundation.

America's Health Rankings chart shows percentages of
Kentuckians with each of eight major chronic conditions.

Most of the reasons are familiar, such as a high percentage of Kentuckians with more than one chronic condition -- such as diabetes, which has become more common in recent years, and cardiovascular disease, including high blood pressure.

Only one state, West Virginia, has more residents with multiple chronic conditions.

But while many of the reasons for the low ranking are familiar, some of them have become worse in recent years.

America's Health Rankings chart

For example, in the last four years of the rankings, the percentage of Kentuckians who met the federal guidelines for physical activity -- 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, plus two days a week of muscle strengthening -- has declined, while the national percentage has been going up. Kentucky is now last in the nation for this metric.

Unlike previous annual reports, the 31st America's Health Rankings does not assign states an overall ranking, citing the health challenges of the coronavirus pandemic. However, a comparative look at the overall numbers places Kentucky 44th among the states.

That's better than the state's two main rankings, due to other ranking categories.

The latest America's Health Rankings used a new model that examines 74 measures of population health in categories that include social and economic factors, physical environment, clinical care, behaviors and health outcomes. Prior reports have only examined 35 measures of health. 

The measures are in several categories. One where Kentucky did well, raking 19th, is Physical Environment, which includes a wide range of factors that influence where individuals live, work and play, and include things like air and water quality, climate change, housing and transit. 

The shining star in this category is the state's No. 1 ranking for water fluoridation, a scientifically proven policy that appears to be under attack.

Kentucky health regulations require most water systems to add fluoride to reduce tooth decay, a significant problem in the state. Sen. Steve West, R-Paris, filed a bill in the last legislative session to let local governments or special districts exempt themselves from the rule. It appears that a similar bill will likely be filed during the upcoming one, since advocates both for and against adding fluoride to water testified in September at the Interim Joint Committee on Local Government, WTVQ reports.

America's Health Rankings chart, relabeled by Ky. Health News

Also in the physical environment category, Kentucky ranked 31st in the percentage of residents who are covered by 100% smoke-free laws applying to workplaces and public spaces. As of Oct. 1, 36.2% of Kentuckians are protected by such laws, according to the Kentucky Center for Smoke-Free Policy.

In the Clinical Care category, Kentucky ranked 31st, largely due to its low share of uninsured adults, 6.4%, which has driven down by the state's embrace of the Patient Protection and Affordable Care Act and its expansion of Medicaid. The uninsured rate rose from 5.6% in 2018 to 6.4% last year.

Another strength in the Clinical Care category is the percentage of Kentuckians who report having a dedicated health-care provider, nearly 82%. That may also be a reflection of the Medicaid expansion.

But gaps remain. The category includes bottom-10 rankings for adult dental visits, childhood immunizations and preventable hospitalizations.

In the Social and Economic Factors category, Kentucky ranked 34th. Its strengths in this category were a No. 3 ranking for high-school graduation rate, 90.3%, and a No. 10 ranking for decreasing the racial gap in graduates. Another strength is the state's low rate of violent crime.

The state had two measures in this category that ranked in the bottom 10 of states: a high index of high economic hardship, which compares financial strain between states, and a high percentage of Kentucky households with food insecurity, 14.7%. 

America's Health Rankings chart, relabeled by Ky. Health News

In Health Outcomes, Kentucky ranked 46th. Of these measures, Kentucky ranked among the bottom 10 states for nine measures, including: depression (49th), frequent mental distress (45th), drug deaths (41st), premature deaths (47th), frequent physical distress (48th), multiple chronic conditions (49th), high blood pressure (46th), high cholesterol (49th) and obesity (45th). 

In the Healthy Behaviors category, Kentucky ranked 48th, which should come as no surprise since the state ranked in the bottom five states for insufficient sleep (48th), exercise (50th), fruit and vegetable consumption (50th), physical inactivity (48th), teen births (47th) and smoking (49th). 

Those are all determinants of health, a sub-category in which Kentucky ranked 43rd among the states. 

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Study of young people's e-cigarette use early in pandemic shows many had quit or cut back, but many under 21 were still buying

By Melissa Patrick
Kentucky Health News

Nearly 70% of  young people who told researchers they had changed their electronic-cigarette habits had either used e-cigarettes less or had quit altogether since the coronavirus pandemic hit in March, largely because of either stay-at-home orders or because of difficulty accessing the products. 

Tobacco21.org photo

That's the upshot of a national survey of underage youth and young adults who said they had ever used e-cigarettes, taken May 6-14. The online research had 4,351 participants aged 13 to 24, with 2,167 of them -- just short of half the total -- reporting they had ever used e-cigarettes.

The study report says, "Understanding such patterns and shifts may inform the development of timely and age-appropriate public health messaging and provide insights on policy levers for long-term prevention of underage access to and use of e-cigarettes."

The report also says understanding patterns of e-cigarette use is important during the pandemic because e-cigs may put users at risk for more severe respiratory effects, as well as other health problems. 

The study, published in JAMA Network Open, found that 56.4% of e-cigarette users reported changing their habits since the pandemic began, with 388 (32.4%) quitting, and 422 (35.3%) reducing their consumption of nicotine. On the other hand, it found that 211 (17.6%) increased their nicotine consumption, 94 (7.8%) increasing their use of cannabis, and 82 (6.9%) switched to other products.  

Of  the 895 e-cigarette users who gave a reason for decreasing their use since the pandemic, one-fourth said it was because e-cigarettes may weaken their lungs. Nearly 20% said it was because they could not get the products; 15% said they were at home, so their parents would know; and about one-third said it was a combination of two or more of those reasons. The rest provided other reasons.

Top reasons given by those who increased their use were boredom, stress, the need for a distraction or a combination of those reasons.

The survey also asked about the ease or difficulty in obtaining e-cigarette products during the pandemic. It found that the top three reasons cited by 1,939 participants were difficulty getting to the grocery store or gas station (28.7%); shipping times for online orders (21.2%), and inability to get to the shop (19.4%). 

Some said it was easier to buy in the pandemic. Of those 261 participants, about one-third reported that their retail source was delivering it to them directly; about one in five said the retailer was delivering it to a friend; and nearly 20% (including 21 underage youth) said they had switched to buying online.

The survey found a shift to online buying, especially among young adults. 

Nevertheless, the study found that "vape" shops and online retailers are selling e-cig products to underage youth during the pandemic, and 63 of 229 underage youth, or 27.5%, said they had accessed e-cigs without age verification. 

Of the 154 underage youth who reported having to provide age verification, 73% said they had to physically show their ID; 7% gave an e-mail login, 18% uploaded ID information; and 2% said "other." 

The researchers called on the U.S. Food and Drug Administration to "use its authority to prevent online sales of e-cigarettes to underage youth and to deny marketing authorization to e-cigarette companies whose premarket tobacco product applications can't prove that they can stop underage youth from buying their products." 

The report says, "Underage youth who turn to online purchases of e-cigarettes during the pandemic in lieu of their previous sources may continue to use these easy-access means, making online prohibitions or age verification even more essential." 

It also calls for state and local governments to require effective age verifications for online sales and to take away licenses and/or issue penalties on companies that continue to sell to those who are underage. 

The researchers also stress the need for improved access to cessation programs, noting that many of the youth and young adults who reported no reduction in  their e-cigarette use during the pandemic had increased use of the products prior to the pandemic and increased nicotine dependence. 

The researchers also point out that the least-cited reason for decreased e-cigarette use after the pandemic was that "parents will know," which suggest that the easily hidden products allow underage youth to continue to hide and use the products at home, even with family members nearby. 

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McConnell puts fix for 'surprise billing' problem in must-pass bill

McConnell on Dec. 15 (Pool photo by Rod Lamkey via AP)

The massive bill to keep the government open and provide $900 billion in pandemic relief also includes a compromise solution to the nagging problem of "surprise billing" in health care, key members in both parties said Sunday night.

Senate Majority Leader Mitch McConnell, who was pulled in opposite directions on the issue and had remained mum about it, made the final call, Susannah Luthi of Politico reports.

"While the health-care industry agreed that patients should be held harmless in emergency situations, hospital and physician groups and insurers fought vigorously over who would pick up the tab," Luthi reports. "The compromise deal congressional committees struck earlier this month was considered largely a win for hospitals and doctors —and tweaks made in the final legislation are even friendlier to providers, according to a summary obtained by Politico." 

The key change is in the negotiation procedure for health-care providers and insurance companies to resolve billing disputes or take them to a mediator. "The bill would forbid arbiters from taking into account Medicare and Medicaid rates, which are typically much lower than what commercial coverage pays," Luthi writes. "That is a loss for insurers, employers who fund a major chunk of private coverage, and patient advocates who thought including those public rates as a barometer could help curb health-care prices. As a guardrail, the measure also bars arbiters from considering providers' billed charges, which are usually well out of line with what insurers or patients end up paying."

The most common form of surprise billing comes when a patient it treated by a provider, or transported by an emergency medical service, that is not in the network called for by the patient's insurance policy.

Surprise billing is a problem in Kentucky. "A 2018 survey found that 32% of privately insured Kentucky adults reported receiving a medical bill that included an unexpected expense in the previous year," Butler County Republican Party Chair Matthew Embry wrote in a Dec. 2 piece for the Courier Journal. "To make matters worse, 70% of patients who were hit with surprise medical bills had no idea they were receiving treatment from a provider outside of their insurance network. . . . If the patient can’t afford to pay astronomical surprise bills, they can be harassed by collection agencies, threatened with legal action and even forced into bankruptcy."

The bill's passage is a big capstone for the political career of retiring Sen. Lamar Alexander, R-Tenn., a close friend of McConnell. But one of the majority leader's biggest business constituents is Humana Inc., the Louisville insurance firm. 

Insurers did appeared to get something in the final deal, Luthi reports: "Lawmakers appear to have watered down a measure that would have required them to disclose detailed information to employers about their drug costs and rebates through their contracts with middlemen known as pharmacy benefit managers, whose business practices have come under scrutiny in recent years for their role in high drug costs. Instead, the legislation calls for insurers to submit more general information on medical costs and prescription drug spending to relevant federal agencies, which would feed into a government report on drug pricing trends."

The U.S. Supreme Court recently ruled that states could regulate pharmacy benefit managers, which the Kentucky legislature recently decided to regulate, partly in an effort to help independent pharmacies deal with competition with pharmacy chains than operate PBMs. 

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Moderna vaccine arrives in Kentucky; 26 deaths push 7- and 14-day means to new highs; Congress finalizes $900 billion relief bill

A UPS truck with Moderna vaccine got a police escort in Louisville. (Image from WAVE-TV)

By Al Cross

Kentucky Health News

As the second coronavirus vaccine arrived in Kentucky, new cases and hospitalizations for Covid-19 kept falling, but 26 more deaths continued a surge.

The state reported 1,765 new cases, fewer than reported on any of the last five Sundays. That kept pushing the seven-day rolling average down, to 2,761, the lowest since Nov. 30.

The decline “shows that the steps we have taken, the sacrifice to mitigate and slow the exponential growth of this virus, is working,” Gov. Andy Beshear said in a press release. “But remember, deaths track cases. And so, that exponential growth -- we’re seeing the harm from it right now.” 

The first doses of the Moderna vaccine arrived at the United Parcel Service hub in Louisville just before 10 a.m. Kentucky's allocation is 76,700 doses, about double the amount of the Pfizer Inc. vaccine that arrived last week. (Another 27,300 Pfizer doses are expected this week.)

“We hope on Monday or Tuesday at the latest we will be giving that vaccine, especially to hospital workers all across this commonwealth,” Beshear said. The state has not revealed a distribution plan, beyond the 11 hospitals that got the Pfizer vials due to their locations an ultra-cold-storage capacity.

Vaccinations of nursing-home residents and employees, which are being handled by CVS and Walgreens, are to start Monday. After all health-care workers, Beshear has said first responders and K-12 educators would come next, but vaccines won't be generally available until summer.

A Centers for Disease Control and Prevention advisory committee said Sunday that the vaccine should go next to people 75 and older, as well as workers key to the function of society, including teachers, police officers, firefighters, corrections officers and grocery workers.

The panel said the next phase should be for those who are 65 and older or have underlying medical conditions that raise their risk of severe Covid-19; and other essential workers aged 16 to 64, such as those who work in construction, waste disposal, trucking and food service.

Health Commissioner Steven Stack, in Beshear's press release, continued to remind Kentuckians to keep up their guard against the virus.

“All of us have been affected in one or more ways by Covid-19,” Stack said. “Medically, economically, educationally and socially this pandemic has made 2020 hard for Kentucky and our nation. Thankfully, in Kentucky, we’ve made good progress, but we haven’t reached the finish line yet. Watching your space, wearing a mask and washing your hands is still critical to keep you and others safe. Your choices today will affect Kentuckians for years to come.”

All metrics for the pandemic in Kentucky declined Sunday, except deaths and the share of residents testing positive for the virus in the last seven days; that is 8.73 percent, the highest since the 8.79% recorded Dec. 12.

Hospital numbers were down. Kentucky hospitals reported 1,607 Covid-19 patients (the fewest since Nov, 23), 403 of them in intensive care (the fewest since Dec. 7) and 226 on ventilators (down 10.7% from the day before).

Pressure on intensive-care units has declined in the past week. Three of the state's hospital readiness regions (Barren River, Lake Cumberland and the easternmost, from Lee to Pike counties) still have more than 80% of their ICU beds occupied but the highest is 83.8% (in the easternmost region).

Sunday's 26 confirmed deaths pushed the daily death averages to new highs: a seven-day mean of 27.1 and a 14-day mean of 23.2.

Five of the 26 deaths were in Southern Kentucky's Russell County, population about 18,000, which had a large surge of cases recently. One victim, a woman, was only 49. The others were women 85 and 88, and men 84 and 89.

The other 21 fatalities were a 78-year-old man in Adair County; an 86-year-old Ballard County woman; a Calloway County woman, 96; a Casey County man, 76; a Clinton County man, 74; a Fayette County woman, 67; a Graves County woman, 103; a Hancock County woman, 79; a Hardin County man, 59; a woman, 94, and a man, 92, in Hopkins County; two Jefferson County men, 73 and 86; a Muhlenberg County woman, 95; two Owsley County men, 55 and 89; a Pike County man, 81; a Rowan County man, 73; a in Spencer County man, 86; a Todd County woman, 88; and a Washington County woman, 81.

Late Sunday afternoon, Congress agreed on a $900 billion relief package that includes "a $300 boost in weekly unemployment benefits, $600 relief checks for individuals, more than $300 billion for small business aid and huge pots of money for schools, hospitals and vaccine distribution," Politico reports. "Negotiators left behind an attempt to marry a liability shield with aid for state and local governments after it proved impossible to negotiate."

Senate Majority Leader Mitch McConnell said in a floor speech, "As our citizens continue battling the coronavirus this holiday season, they will not be fighting alone. For workers at the hardest-hit small businesses, there will be a targeted second draw of the Paycheck Protection Program." He added, "We’re going to supply this emergency aid in a way that is smart and responsible. We will be repurposing more than $560 billion in money that was already set aside by the CARES Act — but not spent — toward these urgent needs."

The bill, which does a panoply of things, also includes long-debated legislation to solve problems with "surprise billing" in health care, Politico reports.

In other coronavirus news Sunday:

• Counties with 10 or more new cases were: Jefferson, 276; Fayette, 165; Warren, 114; Kenton, 99; Boone, 92; Campbell, 59; Carter, 54; Greenup, 39; McCracken, 36; Boyd and Hardin, 32; Daviess, 30; Whitley, 26; Christian, 25; Bullitt and Pulaski, 23; Boyle, McCreary and Muhlenberg, 22; Letcher, 20; Calloway, Franklin and Garrard, 19; Pike, 17; Johnson and Taylor, 16; Henderson, Madison and Scott, 15; Laurel, 13; Adair, 12; Jessamine, 12; Wayne and Woodford, 11; and Bell, Grant, Graves and Nelson, 10.
• Researchers at the University of California, San Diego report "facemasks do not significantly change the actual work of breathing or the flow of oxygen and carbon dioxide when worn while exercising."

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Paper says it has 'story of how Trump’s denial, mismanagement and magical thinking led to the pandemic’s dark winter'

Vice President Pence speaks for the task force March 9. (Photo by Jabin Botsford, Washington Post) 

A month ago, as doctors on the White House Coronavirus Task Force watched new cases rising and feared the Thanksgiving holidays would make things worse, and "their warnings had gone largely unheeded for months," they "decided to stage an intervention," The Washington Post reports.

The four "sounded new alarms, cautioning of a dark winter to come without dramatic action to slow community spread. White House Chief of Staff Mark Meadows, among the many Trump aides who were infected with the virus this fall, was taken aback, according to three senior administration officials with knowledge of the discussions. He told the doctors he did not believe their troubling data assessment."

Meadows also accused the four — the task force response coordinator, the nation's top infectious-disease specialist and the heads of the Centers for Disease Control and Prevention and the Food and Drug Administration — "of outlining problems without prescribing solutions," the Post reports. "The doctors explained that the solutions were simple and had long been clear: among them, to leverage the power of the presidential bully pulpit to persuade all Americans to wear masks, especially the legions of Trump supporters refusing to do so, and to dramatically expand testing."

Drs. Deborah Birx and Anthony Fauci with Trump on
March 20. (Photo by Jabin Botsford, Washington Post)

Fauci, who runs the National Institute of Allergy and Infectious Diseases, told the Post, “It was something that we were almost repetitively saying whenever we would get into the Situation Room” at the White House. “Whenever we got the opportunity to say, ‘This is really going to be a problem because the baseline of infections was really quite high to begin with, so you had a lot of community spread.’ ”

On Nov. 19, after the CDC advised against Thanksgiving travel, Vice President Mike Pence, who chairs the task force, "agreed to hold a full news conference with some of the doctors — something they had not done since the summer. But much to the doctors’ dismay, Pence did not forcefully implore people to wear masks, nor did the administration take meaningful action on testing. As for the president, he did not appear at all," the Post reports. "Trump went days without mentioning the pandemic other than to celebrate progress on vaccines."

The arrival of the first vaccine marked "the first glimmer of hope amid a pandemic that for 10 months has ravaged the country, decimated its economy and fundamentally altered social interactions," write Post reporters Yasmeen Abutaleb, Ashley Parker, Josh Dawsey and Philip Rucker. "Yet that triumph of scientific ingenuity and bureaucratic efficiency does not conceal the difficult truth, that the virus has caused proportionately more infections and deaths in the United States than in most other developed nations — a result, experts say, of a dysfunctional federal response led by a president perpetually in denial."

Scott Gottlieb, a former Trump FDA commissioner in the Trump administration, told the Post, “We could have done better galvanizing collective action, getting more adherence to masks. The idea that we had this national debate on the question of whether masks infringed on your liberty was deeply unfortunate. It put us in a bad position.”

Maryland Gov. Larry Hogan (Photo by Ricky Carioti, W. Post)

Larry Hogan, the governor of Maryland and "one of the few Republican officials who have criticized Trump’s handling of the pandemic, said many in the administration are working hard to control the alarming November-to-December surge, but not the man at the top," the Post reports. He told the newspaper, “My concern was, in the worst part of the battle, the general was missing in action.”

On the other hand, "Trump’s defenders say the president and his administration deserve credit not only for Operation Warp Speed — the public-private initiative to develop, test and now distribute vaccines — but also for their work early on to address a shortage of ventilators, ease supply-chain delays for personal protective equipment and set guidelines for businesses and other gathering places to reopen after the March and April shutdowns," the Post reports. "They also point to Trump’s decision in late January to restrict travel from China, where the virus originated. And they say they’re not sure what Trump should have done differently."

Former CDC director Tom Frieden answered that question this way: “Words matter a lot, and what we have here is a failure to communicate — and worse than that, the effective communication of policies, of myths, of confusion about masks, about hydroxychloroquine, about vaccines, about closures, about testing. It’s stunning.”

Before 7,000 more words about the last 10 months, The Post sums it up: "Trump’s repeated downplaying of the virus, coupled with his equivocations about masks, created an opening for reckless behavior that contributed to a significant increase in infections and deaths, experts said." The story is headlined, "The inside story of how Trump’s denial, mismanagement and magical thinking led to the pandemic’s dark winter."

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