Beshear lifts outdoor mask mandate, says 'We will probably do things more incrementally;' Johnson & Johnson vaccine returns

State Department for Public Health chart, relabeled by Kentucky Health News; click on it to enlarge.

By Melissa Patrick

Kentucky Health News

With all of the coronavirus metrics on a plateau in Kentucky, Gov. Andy Beshear announced that starting Tuesday, the state will no longer require masks at outdoor events or venues with fewer than 1,000 people. 

“It means if you are at a backyard barbecue, if you are at your community pool, if you are at an outdoor wedding, especially if you are vaccinated, you are not required to wear a mask,” Beshear said at a news conference. Louisville television stations cited Kentucky Derby parties as the main example.

Beshear encouraged anyone who was not vaccinated to continue wearing a mask, and to get vaccinated. The mandate under his emergency powers is still in effect at indoor events, and outdoor ones with more than 1,000 people, like the Derby, to be held at Churchill Downs in Louisville Saturday, May 1. 

Beshear said he was relaxing the rule because of a growing number of Kentuckians have been vaccinated and new data supports the change. President Joe Biden is reportedly planning to issue similar guidance from the Centers for Disease Control and Prevention Tuesday; Beshear said he had only seen news reports of that possibility.

Beshear has said he would remove all restrictions on business capacity once 2.5 million Kentuckians have received a dose of vaccine, but vaccination rates have slowed each week lately. Beshear noted that, adding later in response to a question, "we probably will do things more incrementally."

The state said 1,726,346 million Kentuckians have received at least one dose of a coronavirus vaccine, which is about 734,000 short of the governor's goal. Kentuckians can find an appointment near them at vaccinemap.ky.gov. 

The state's daily vaccine report added only 2,533 vaccinations yesterday, presumably a reflection of shots administered on Sunday. 

Beshear continues to plead with Kentuckians to get what he calls "a shot of hope" -- not only to reach herd immunity, which will provide some protection for people unwilling or unable to get a vaccine and can be reached when 70% to 85% of people are vaccinated, but to also slow the spread of the more contagious variants of the virus. 

Beshear said Kentucky has confirmed 276 virus cases with variants of concern, and 256 are the highly contagious B.1.1.7 variant, which originated in the United Kingdom and is now dominant in the U.S.

In particular, he is asking Kentuckians between the ages of 20 and 49 to get vaccinated, since they have some of the state's lowest vaccination rates.

Beshear said 75% of Kentuckians 70 and older have been vaccinated; 65% between 60-69 have been vaccinated; 48%  between 50-59 have been vaccinated; 39% between 40-49 have been vaccinated; 34%  between 30-39 have been vaccinated; and 25% between 20-29 have been vaccinated. 

Beshear said he talked Friday with the Kentucky Chamber of Commerce to more than 100 businesses, representing "hundreds of thousands" of employees. 

"My message was, we need your help. We need your leadership. We need you to be creative, we need you to incentivize, we need you to do everything you can to get not just your employees vaccinated, but to encourage others out there in the community," he said. 

He added that he has already seen "some incredible response," including a hospital system that has created a bonus competition among facilities based on vaccination levels and a pop-up vaccine clinic being hosted by Racing Louisville FC, a National Women's Soccer League expansion team. 

He added that he also had a call with mayors and county judge-executives last week. 

"I think we've got a lot of people out there who want to be creative, who have bought in and certainly our business community knows about the disruption that a Covid outbreak could cause in their workplace. and that if we truly want to get back to a normal, not just in our personal lives, but in a steady workforce, that vaccinations are the key," he said. 

A vaccine returns: Health Commissioner Steven Stack announced that the state has resumed using the single-dose Johnson & Johnson vaccine immediately, for anyone 18 and older. 

Stack said some vaccination sites may choose to wait for more federal guidance, which will be released on Tuesday, to help them around their "informed consent" guidelines. He said new shipments of the vaccine will resume next week. 

Stack noted that the federal investigation of the J&J vaccine found 15 cases of women who received it and developed a rare blood clotting condition that also involved low platelet counts, called "thrombosis with thrombocytopenia syndrome," or TTS. He said all were between 18 and 59, and all but two were under 50. 

"There was no association found with birth-control pills or any other sort of medications," Stack said. "There was not a clear pattern, other than the gender association and relative youth of the individuals."

He said they found that among around 8 million people immunized with the J&J vaccine, it has been 85% effective in preventing severe Covid-19 and 93% effective in preventing hospitalizations. "That is incredibly effective," he said. 

Further, he said a J&J analysis found that for every 1 million persons vaccinated with the J&J vaccine, there would be two cases of the TTS syndrome, but those vaccinations would prevent 2,000 deaths from Covid-19 and prevent 6,000 hospitalizations. 

The CDC Advisory Committee on Immunization Practices analysis showed that for every 9.8 million people vaccinated, there would be 26 cases of TTS in women who are 18 and older, but it would prevent 1,434 deaths and prevent 2,236 admissions to the hospital ICU. 

"Analyses from two different methodologies showed that getting vaccinated dramatically increases your risk of death and severe illness, and very minimally raises your risk of having a problem with the vaccine," Stack said. "Nothing in life is without risk. But there is no doubt that the relative balancing of the risks and the benefits show this vaccine to be incredibly effective and incredibly safe." 

 

And for women under 50 who are concerned about the J&J vaccine, Stack said, "There are two other exceptional vaccines out there. Get Moderna. Get Pfizer. . . . For all other persons, at the moment, there is no significant indication that you're undertaking any meaningful risk by getting vaccinated, but there is an enormous mountain of evidence that you are keeping yourself much safer." 

Beshear said the use of the J&J vaccine will resume in prisons, although the state will make the Moderna and Pfizer-BioNTech vaccine available to inmates with concerns. He said the two remaining prisons that have not been vaccinated are men's facilities.  At this time, only 70% of the inmates have been vaccinated. Beshear has said in-person visitation can resume when they reach the 80% mark.

Daily numbers: Beshear announced 213 new cases Monday, lowering the state's seven day average by three, to 522. 

The percentage of Kentuckians testing positive for the virus in the past seven days dropped again, to 3.15%. This rate has hovered in the 3% range since April 11. Health officials like to see this number below 5% as an indicator of lower community spread of the virus.

The weekly averages for both of these measure were lower than the prior week, Beshear said the state continues on a plateau. 

"Remember, every single person who gets vaccinated helps make sure this happens or gets us on the decline," he said. "While I'd like to see more people vaccinated, every week, every person that gets vaccinated makes a big difference." 

The statewide average of new cases over the past seven days was 10.15 per 100,000 residents, down .09 from yesterday. The New York Times ranks Kentucky 38th among the states.

Counties with double the statewide rate were Lewis, 38.7 per 100,000;  Bath, 36.6; Powell, 34.7; Montgomery, 27.4; Robertson, 27.1; Mason, 26.8; and Morgan, 24.7.

Kentucky hospitals have 414 Covid-19 patients (down 33 from Sunday); 108 in intensive care (down 20); and 47 of those on a ventilator (up 2). Beshear said these numbers have largely plateaued as well. 

The Lake Cumberland hospital readiness region is the only region using at least 80% of the beds in its intensive care units, at exactly 80%. Only 13.3% of the ICU beds have Covid-19 patients. 

Eleven more Kentuckians were added to the list of Covid-19 fatalities, four of them from regular health-department reports and seven from an ongoing audit of death certificates. The death toll is 6,459. 

The regularly reported fatalities were in April, March and January. They were a Hart County woman, 67; a Henry County man, 92; and two Jefferson County women, 55 and 73.

The audit fatalities were all from November and December. They were a Garrard County man, 82; a Greenup County woman, 71; a Henderson County woman, 80; two Jefferson County men, 71 and 84; a Nelson County woman, 95; and a Spencer County man, 96. 

In other pandemic news Monday:

• Counties with five or more new cases were Jefferson, 56; Daviess, 15; Fayette, 14; Bullitt, 9; Graves and Montgomery, 6; and Christian, Hardin, Jessamine, Kenton, Knox and Laurel, 5. Sixty-six of the state's 120 counties reported no new cases. 
• In long-term care, there were five new resident cases and nine new staff cases, bringing the total number of active cases to 57 residents and 90 staff. Beshear reported three Covid-19 deaths in the facilities, one of them considered new and two from the ongoing audit of death certificates. The death toll from Covid-19 in long-term care is 2,286. 
• Fayette County Public Schools will offer the Pfizer-BioNTech coronavirus vaccine for students, families and staff at its six main high schools Tuesday. All Fayette County students 16 and older are eligible, reports the Lexington Herald-Leader . Students who are fully vaccinated two weeks past the second shot may not need to quarantine, Valarie Honeycutt Spears reports. 
• The Lexington-Fayette County Health Department announced that it would start vaccine that would accept walk-in patients without appointments, to reach more people who are casual about getting a shot. The department noted that half of the county's people are fully vaccinated.
• The J&J vaccine was paused for 10 days after TTS occurred in six women, among more than 7 million people who had received the vaccine. Later, there were nine more confirmed cases, and a handful of other possible cases are under review, according to Dr. Tom Shimabukuro, a member of the CDC's Covid-19 Vaccine Task Force, NBC reported April 23. Among the confirmed cases, three patients died and seven others remain hospitalized. All cases were in women, and all but two were in women ages 18-49. Seven were among women in their 30s, among whom the rate was 11.8 cases per million doses of the J&J vaccine administered.