State and schools get new Covid-19 guidance; Beshear makes employee masks optional; state will go from daily to weekly report

State Dept. for Public Health graph, adapted by Kentucky Health News; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

As Kentucky came close to leaving the statewide "red zone" for coronavirus infection, Gov. Andy Beshear told state employees they could take off their masks and made the state's guidance for school districts – which seem to have largely dropped mask mandates – conform to new federal guidelines.

From Saturday to Monday, the state reported 2,754 new cases of the coronavirus, reducing the seven-day rolling average to 1,889, about half what it was just 10 days ago.

In the Monday-to-Sunday reporting week ended Feb. 27, Kentucky reported 13,305 virus cases, just over half the 25,173 reported the previous week. 

In the same reporting week, the average positive-test rate fell to 9.01%. The rate Monday was 8.56%. Beshear said Kentucky is seeing a steady positivity rate decline of about one-half point per day. 

"The metrics are all continuing to move in the right direction, and they're moving very quickly in the right direction," Health Commissioner Steven Stack said at Beshear's weekly pandemic press briefing. 

Beshear said, "The pace of the decline continues to be significant. We want to continue to see these numbers going down. Right now, there's no reason to think that they won't." 

The governor said that with a few exceptions in congregate settings, state government is moving to a mask-optional policy, which will also apply to visitors. 

Beshear and Stack reviewed the Centers for Disease Control and Prevention's new masking guidance that is based on three indicators: cases in the past seven days, Covid-19 hospital admissions, and share of staffed beds occupied by Covid-19 patients. Those numbers rate each county as low, medium or high risk, with recommendations to fit.

New Centers for Disease Control and Prevention guidelines for Covid-19 prevention; click to enlarge 

The CDC says people in high-risk counties, currently 104 of Kentucky's 120, should still wear masks in indoor public spaces. Stack said he expected that number to drop with the CDC's next weekly advisory.

In the 18 counties at medium risk, it says people who are immunocompromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."

Asked about likely compliance with this new guidance, Beshear said, "We always say that having more specific and more targeted guidance will help with compliance. We just need a commitment by our local leaders, but also all our individual families."

Starting next week, Stack said the state will switch to a weekly Covid-19 update that will coincide with the CDC's weekly update of the risk map: "It's much more appropriate as we look to start the third year of the pandemic. It gives timely information but it's also responsive to the realities of where we are."

Stack said his Department for Public Health is updating its school guidance to align with new CDC guidance that will make masks optional in schools in areas with low virus transmission, with targeted mask use following at-school exposures. The guidance will also recommend that schools in areas with medium transmission should consider universal masking for all students and staff and those in high transmission areas should require universal masking. 

Stack encouraged parents to get their school-aged children vaccinated, in part to prevent Multisystem Inflammatory Syndrome. He said about 100 Kentucky children have been diagnosed with this rare but serious condition that can occur two to six weeks after a Covid-19 infection, even in children who have mild infections or no symptoms at all.

Stack said he shared this information because more and more evidence is showing that vaccines largely prevent MSIS: "So please, our vaccination rates remain lowest in the school aged children. I would urge parents to be thoughtful about that, talk with your pediatrician and get your children vaccinated."

Twenty-one percent of today's new Covid-19 cases were in children. 

Kentucky Department for Public Health table

So far, only 48% of Kentucky's 12- to-15-year-olds and 51% of 16- to-17-year-olds and 22% of 5- to-11-year-olds have received at least one dose of a Covid-19 vaccine. 

CDC data reported by The Washington Post says that in the last week, Covid-19 vaccinations in Kentucky averaged of 2,918 per day. That which up a bit from Saturday, when the average was 2,508, but still a 46% decrease from the week before.

"If there's one negative piece of information today," Beshear said, "it's that our vaccination numbers are dropping about as quickly as the virus itself."

The state's seven-day infection rate is 27.79 daily cases per 100,000 residents, barely in the "red zone" for a high level of transmission, above 25 per 100,000. But many counties still have very high rates.

Counties with rates more than double the statewide rate are Wolfe, 161.7; Perry, 153.1; Menifee, 118.9; Leslie, 105.6; Robertson, 88.1; Lawrence, 84.9; Knott, 80.1; Letcher, 76.9; Wayne, 76.6; Owsley, 74.4; Crittenden, 73; Martin, 72.7; Breathitt, 71.3; Morgan, 69.8; Bath, 69.7; Magoffin, 69.3; McCreary, 68.8; Jackson, 66.5; Lee, 65.6; Floyd, 63; Clay, 56.7; Anderson, 55.9; and Montgomery, 55.8.

Kentucky's infection rate continues to rank sixth among states, even with a 53% decline in cases in the last 14 days, according to The New York Times. 

The state's Covid-19 hospitalization rate is second only to West Virginia's, but Kentucky's hospitals continued to get relief from the pandemic. They reported 962 patients with Covid-19 Monday, just over half the number reported two weeks ago, with 203 in intensive care and 112 on mechanical ventilation. 

Six of the 10 hospital regions are using at least 80% of their intensive-care beds, with three over 90%. Beshear said 388 National Guard members are still helping hospitals and food banks, but probably won't be needed after March 15. 

Asked about the legislation by Sen. Donald Douglas, R-Nicholasville, to end the Covid-19 state of emergency on March 7, Beshear said "We still have a pandemic" that can't be ignored and we don't need to "do anything that could stop us at any point from getting reimbursement for things that we need."

He said the bill "is more about politics . . . as far as I can tell from the outside . . . individual elections and pressure that people are facing." Douglas, who won a special election in November, is running in the May 17 primary election against Andrew Cooperrider of Lexington, who flouted Beshear's emergency pandemic restrictions and led protests against them.

From Saturday to Monday, Kentucky attributed 98 more deaths to Covid-19, bringing its pandemic death toll to 13,856. Beshear said two of the dead were in their early 20s and five were in between 39 and 49. 

"Remember," he said, "we're still losing people that are far too young."

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Flu cases in Ky. still low, but state reports a flu-related death

By Melissa Patrick
Kentucky Health News

Kentucky has reported its first death from influenza this season, even as flu cases have remain low and stable for about four weeks. 

The state Department for Public Health says that in the week ended Feb. 19, it counted only 83 flu cases, down from 85 the previous week. The state has recorded 2,744 cases this season and one flu-related death, recorded this reporting week.

The state's flu level is "regional," which applies when increases in flu cases have been confirmed in at least two, but fewer than half, of the state's 16 regions. Flu season usually peaks between December and March, but can run through May.

Flu cases could be higher than the report says, since it only lists cases that have been laboratory-confirmed, not those confirmed by a rapid test.

As long as there is any flu activity, health officials recommend getting a flu shot.

"An annual flu vaccine is the best way to protect against flu and its potentially serious complications. CDC continues to recommend that everyone ages 6 months and older get a flu vaccine as long as flu activity continues," says the national flu report, which says flu activity is sporadic across the country, but is increasing in some states.

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Bill would let Medicaid to pay certified community health workers

By Melissa Patrick
Kentucky Health News

A bill to require Medicaid reimbursement for certain services provided by certified community health workers, and streamline their certification process, awaits a vote in the full House. 

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy and deliver education on prevention and disease self-management.

Rep. Kim Moser speaking at a Feb. 17 news 
conference about HB 525. (Photo from news release) 

"What makes community health workers unique is not that they are necessarily clinical professionals, rather they are the point guard in helping individuals understand what resources are available," Rep. Kim Moser, R-Taylor Mill, said at a press conference about the bill in a video from the Kentucky Primary Care Association. 

The federal Bureau of Labor Statistics says Kentucky had 1,350 CHWs in May 2020, with an annual average wage of $37,320.

House Bill 525, sponsored by Moser, would require the Department for Medicaid Services to seek federal approval for a state plan amendment, waiver or alternative payment model, including public-private partnerships, for services delivered by certified CHWs.

Teresa Cooper, director of government affairs for the KPCA, said in an e-mail that CHWs are hired as a staff person by a facility, but their services cannot be billed to Medicaid or private insurance. "This legislation would allow the clinic to bill for their services and receive reimbursement or count them in their cost of operations," she said.

The bill would also require CHWs to be employed and supervised by a Medicaid-participating provider and says as of Jan. 1, 2023, "no person shall represent himself or herself as a community health worker unless he or she is certified as such" in accordance with the provisions laid out in the act. 

The bill passed out of the House Health and Family Services Committee, which Moser chairs, on Feb. 24. She pointed to a Kentucky Homeplace study that found between July 2001 and June 2021, community health workers achieved a return on investment of $11.32 saved for every $1 invested in their services. 

"The cost-benefit analysis has shown it to be a very productive use of our taxpayer dollars," she said, adding that because Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act in 2014, the program serves 1.6 million Kentuckians, about one of every three. 

"We know that it's time, because of this Medicaid expansion, to really get more targeted with our Medicaid dollars and work on programs that work," Moser said.

Emily Beauregard, director of Kentucky Voices for Health, said Moser's bill, if passed, could be a "real game-changer" toward providing a sustainable funding source for community health workers in Kentucky. 

"House Bill 525 creates a very, very important pathway to expand our current network of community health workers," Beauregard said.

Pamela L. Spradling, a CHW with Big Sandy Health Care, a federally qualified health center in Prestonsburg that covers five counties, said their CHWs are currently  paid as staff or through grant funding. 

Asked what it would mean for them to be able to bill Medicaid, she said, " That would be huge for us because it would mean sustainability for our program. . . we wouldn't have to constantly be worrying about where the money is going to come from to pay our community health workers." She added that the challenge with grant funding is that when the grant money runs out, so does the CHW program. 

Spradling also spoke to the value of CHWs in changing health outcomes, noting that 62% of their 150 patients with diabetes who have a CHW have seen a 2.5 point reduction in their A1C, and some of them with even higher reductions. An A1C is a blood test for diabetes that measures your average blood sugar levels over the past three months. A normal A1C level is below 5.7%. 

Tiffany Taul Scruggs, a certified CHW and the patient service outreach coordinator for Sterling Health Care, a federally qualified health center based in Mount Sterling, said the CHWs in her facility are either on staff or paid for by grants. 

"If we could bill Medicaid, we could probably hire more community health workers just because we have such a big population in our coverage area," she said. "It would be wonderful if we could bill." 

Scruggs noted several services their CHWs provide, including helping their patients obtain medical equipment, medications and food, helping patients navigate the health care system and providing health education. She added that one their greatest needs is transportation to and from medical appointments. 

"I am proud to say our transportation service has provided just shy of 1,300 rides to our most vulnerable population in 2021," she said in a statement prepared for the House committee. "The team consists of one full-time driver, one part-time driver who was recently hired, two outreach and enrollment specialists, and three community health workers ready to assist our patients when needed." 

Tammy Collett, Cumberland River regional director for Mountain Comprehensive Health Corp. in Whitesburg, said in an e-mail that funding for their CHWs is provided through a grant from Marshall University, The University of Chicago and the Merck Foundation. She said the goal of this grant program is to demonstrate the effectiveness of using CHWs to improve health outcomes and quality of life. 

"It is our hope that payers will recognize the benefit of CHWs and consider coverage for their services," Collett said.

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Kentucky's coronavirus infection rate is sixth among the states and its Covid-19 hospitalization rate ranks second

New York Times graphs show top nine states in infection rates, and the national rate. Click to enlarge.

By Al Cross
Kentucky Health News

The waning pandemic continues to be stronger in Kentucky than in all but a few states, according to the latest New York Times rankings based on data from the Centers for Disease Control and Prevention. 

Kentucky's seven-day infection rate, 48 daily coronavirus cases per 100,000 residents, is sixth in the among the states. Its rate of hospital patients with Covid-19 is second, at 30 per 100,000. West Virginia's rate is 42.

Among U.S. counties and county equivalents, Perry County has the third highest infection rate, and it is first among true counties. The higher rates are in an independent city in Virginia and a census area in Alaska.

Perry's rate is 222 daily cases per 100,000 residents over the last seven days. Seventh on the list is Morgan County, at 188; at 12th and 13th are Pike and Knott, at 137 and 133, respectively. Wayne County is 17th, at 130, and adjoining Scott County, Tenn., is 15th at 132. Several other East Tennessee counties on or near the Kentucky border are in the top 100.

Other Kentucky counties in the top 100 are Breathitt, 21st at 121 cases per 100,000 residents; Letcher, 29th at 112; Floyd, 31st at 110; Bath, 33rd at 109; Adair, 39th at 103; Butler, 45th at 101; McCreary, 46th at 99; Martin, 48th at 97; Taylor, 49th at 95; Lawrence, 50th at 95; Clay and Magoffin, 53rd and 54th, at 93; Montgomery, 65th at 88; Laurel, 70th at 85; Powell, 71st at 84; Whitley and Grayson, 75th and 76th, at 84; Trigg, 80th at 81; Knox, Jackson and Anderson, 82nd, 83rd and 84th, at 79; Harlan, 88th at 79; Carter, 89th at 78; Clark, 95th at 75; and Rowan, 100th, at 74 cases per 100,000 residents.

Hospitalization figures are less certain, because they are based on hospital service areas but ranked by county. Pike, Perry, Letcher, Knott, Laurel, Martin, Harlan, Clay, Jackson, Floyd, Boyd, Whitley, Fayette, Bourbon, Clark Jessamine and Lawrence counties are in the Times' top 100 counties.

The next report from the Kentucky Department for Public Health is due tomorrow afternoon, at and after Gov. Andy Beshear's weekly pandemic press briefing at 4 p.m.

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Pandemic state of emergency would end March 7 under resolution state Senate sent to the House on a party-line vote

Sen. Donald Douglas (Legislative photo) 

By Melissa Patrick
Kentucky Health News

The Senate has sent the House a resolution to end the Covid-19 state of emergency in Kentucky on March 7.

Senate Joint Resolution 150, sponsored by Sen. Donald Douglas, R-Nicholasville, would end the state of emergency Democratic Gov. Andy Beshear declared March 6, 2020, nearly two years ago. The legislature recently set it to expire on April 15. 

The resolution would end "all subsequent executive orders, emergency administrative regulations, suspensions of statutes, and other directives which rely upon the declaration of emergency."  

And it says the governor "shall not" declare a new Covid-19 state of emergency "based upon the same or substantially similar facts and circumstances as the original declaration" without the prior approval of the General Assembly. 

The resolution passed the Senate Thursday, Feb. 24. on a party-line vote of 28-8. Including Douglas, the resolution has 18 sponsors. 

While presenting the bill on the Senate floor, Daniels acknowledged that when the virus was first announced, there were many unknowns that drove decision-making, but he said it quickly turned political. 

"Instead of proceeding down a purely medical path, it seems that politics took a major role and  sometimes even the lead," said Douglas, a physician. "The emergency seemed to be more about emotion and feeling and a lot less about objectivity and facts."  

He said the focus has been on cases and deaths, without an understanding that "many more people recovered without issue," causing our citizens to be "terrified." As of Feb. 25, there have been 1.3 million Covid-19 cases in Kentucky and 13,758 deaths attributed to it, most in people over 60. However, as many as a third of people with Covid-19 have reported lingering effects.

Douglas noted that the state of emergency led to cancellation of elective medical procedures, business shutdowns, loss of jobs, mask mandates and travel restrictions, and said "the Kentucky State Police were directed to target church attendees . . . to pull the attendees of the church out of the church.”

That is not true. Beshear ordered state police to go to parking lots of churches that held in-person services on Easter 2020 and place on cars notices saying that attendees were in violation of his order against mass gatherings and that they should quarantine themselves for 14 days.

Douglass also cited a Johns Hopkins University meta-analysis of 24 studies that looked at the effects of lockdowns on Covid-19 deaths. The researchers found lockdowns in the U.S. and Europe reduced Covid-19 mortality by an average of 0.2 percent; that shelter-in-place orders reduced mortality by 2.9%; and that there was no broad-based evidence of noticeable effects from non-pharmaceutical interventions. 

The study concluded, "While this meta-analysis concludes that lockdowns have had little to no public-health effects, they have imposed enormous economic and social costs where they have been adopted. In consequence, lockdown policies are ill-founded and should be rejected as a pandemic policy instrument."

Douglas said, "It is time to move to normalcy." He said the March 7 date would give Beshear time to file any administrative regulations that are needed and ensure that the lawmakers are still in session when the emergency ends.

He added that it is not his intent to decrease or interfere with any federal funding, but Sen. Morgan McGarvey, D-Louisville, said it remains unknown if the resolution would affect federal funding such as the additional nutrition benefits that have been made available to children and families.

Sen. Karen Berg, D-Louisville, also spoke against the resolution, saying it is premature because the percentage of Kentuckians testing positive for the virus remains too high and only 60% of eligible Kentuckians have received even a single dose of a Covid-19 vaccine.

When Berg spoke, the positive-test rate was around 10%, after being above 30% for much of January. Early in the pandemic, public-health officials said caution is required when the rate is above 5%. 

Vaccination rates are also slowing. Over the last seven days, the average number of Covid-19 vaccinations in Kentucky was 2,508 per day, the lowest since the Centers for Disease Control and Prevention began gathering reliable data in January 2020. Most of the shots were boosters. State and CDC data show that 64% of the total population have received at least one dose of a vaccine, 56% are fully vaccinated and 43% of the eligible population is boosted.

Sen. David Yates, D-Louisville, asked his colleagues, “Why are we doing it? This doesn’t change anything. . . . I actually cannot wait until I can join in support of it, but what is the rush? I vote no.”

Gov. Andy Beshear said on Feb. 21, "We don't have any state restrictions left . . . and we haven't in a long time."

Douglas, who won a special election in November, is running in the May 17 primary election against Andrew Cooperrider of Lexington, who flouted Beshear's restrictions and led protests against them.

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Rate of new vaccination against coronavirus in U.S. at new low; new and additional vaccination in Kentucky also at record low

Rates of new and additional vaccination against the coronavirus in Kentucky and the nation have hit new lows.

Over the last seven days, the average number of Covid-19 vaccinations in Kentucky was 2,508, the lowest since the Centers for Disease Control and Prevention began gathering reliable data in January 2020.

Most Kentucky vaccinations are booster shots for people who already had two doses of the Moderna or PfizerBioNTech messenger RNA vaccines or a single dose of the Johnson & Johnson vaccine.

Nationally, as the pandemic wanes, first-dose vaccinations are at a record low, The New York Times reports.

"The country’s campaign to vaccinate its population seems to have hit a wall, with very few people showing up for first shots," Ada Petriczko writes for the Times. "An average of 76,000 Americans a day received their first dose this week, the lowest number since December 2020. The number of overall doses per day, including first doses, second doses and boosters, is also at its lowest since around then."

People "who are vaccine-hesitant or vaccine-resistant now have fewer incentives to change their minds," Petriczko notes. "The numbers of Covid-19 cases, hospitalizations and deaths are falling, and many states are pulling back on mask mandates." Also, the CDC recently relaxed its mask guidelines.

Physicians like pediatrician Irwin Redlener are frustrated. “Speaking to patients who are vaccine-resistant is one of the most frustrating things I have ever done as a doctor,” Redlener, director of the National Center for Disaster Preparedness, told the Times. “The odd thing here is that the typical public health messages, such as ‘If you get Covid and you’re not vaccinated, you have a 20 times greater chance of dying than if you had been vaccinated,’ just don’t seem to work with these patients. The black-and-white scientific reality is in a serious conflict with misinformation.”

Redlener said “There’s a lot of wishful thinking that we are done with the pandemic, which we are not. I wouldn’t be worried if people were saying, ‘We’re sick of this, we want to get back to normal, but we’re going to get vaccinated.’ Unfortunately, what we are seeing is a confluence of a delusion of normalcy with vaccine hesitancy.”

About 76 percent of Americans have received at least one dose of a coronavirus vaccine. Petriczko reports, "Experts estimate that with only about 65% of the population fully vaccinated, there is little hope for the United States to reach herd immunity," which protects people unwilling or unable to get a shot.

In Kentucky, 56% of the total population and 60% of the eligible population, those 5 and older, have received at least one dose. Among the population eligible to get a booster, 43% have received one.

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Drug companies' settlement with states and local governments will bring Kentucky $483 million over the next 18 years

The state has finalized a $483 million settlement with four drug companies over their roles in the opioid epidemic, and payments should start in the second quarter of the year, Attorney General Daniel Cameron said Friday.

The 18-year agreement with drug distributors Cardinal Health, McKesson, AmerisourceBergen and manufacturer Johnson & Johnson ends "years of negotiations to resolve more than 4,000 claims of state and local governments across the country," a press release from Cameron's office said. "It is the second largest multistate agreement in U.S. history, second only to the Tobacco Master Settlement Agreement," which settled lawsuits against cigarette makers for health impacts of smoking.

Atty. Gen. Daniel Cameron

Cameron, a Republican, said he would "work closely with the legislature and local governments to ensure the funds are put toward programs that will stop the cycle of addiction and help heal our communities.” The state will get half the money, and the other half will go to local governments through an application process of the new Opioid Abatement Advisory Commission.

The four companies also agreed to:

• Create a clearinghouse to provide all three drug distributors and state regulators with data and analytics about where drugs are going and how often, "eliminating blind spots in the current systems used by distributors," the release said.
• Use data systems to detect and report suspicious opioid orders from pharmacies, and ban shipments of such orders.
• When pharmacies "show certain signs of diversion, stop their shipments and report them to state regulators.
• Prohibit their sales staff from influencing decisions related to identifying suspicious opioid orders, and require senior executives regularly examine anti-diversion efforts.

Johnson & Johnson is required to:

• Stop selling opioids.
• Not fund or provide grants to third parties for promoting opioids.
• Not lobby on activities related to opioids.
• Share clinical trial data under the Yale University Open Data Access Project.

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Under new masking guidance, CDC says people in all but 18 Kentucky counties should still wear masks in indoor public spaces

Centers for Disease Control map, adapted by Kentucky Health News; to enlarge, click on it.

The federal Centers for Disease Control and Prevention has relaxed its guidance for wearing masks to thwart the pandemic, but says infections and hospitalizations in most of Kentucky are so high that people in all but 18 of the state's 120 counties should continue to wear masks in indoor public spaces.

The new CDC system ranks the risk to each county as high, medium or low, based on new coronavirus infections, new Covid-19 hospital admissions, and the share of staffed hospital beds occupied by patients with the disease. That puts 104 Kentucky counties at high risk, invoking the masking guidance.

In the 18 counties ranked at medium risk, the CDC says residents who are immunocompromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."

The 18 Kentucky counties with medium risk are Fulton, Calloway, Todd, McLean, Warren, Green, Taylor, Adair, Russell, Cumberland, Clinton, Trimble, Gallatin, Owen, Pendleton, Bracken, Mason and Fleming.

No Kentucky counties are in the low-risk category. In such counties, the CDC advises, "Wear a mask based on your personal preference, informed by your personal level of risk."

The CDC also advises, "You may choose to wear a mask or respirator that offers greater protection in certain situations, such as when you are with people at higher risk for severe illness, or if you are at higher risk for severe illness. It is important to wear a mask or respirator when you are sick or caring for someone who is sick with Covid-19. When caring for someone who is sick with Covid-19, a respirator will provide you the best level of protection."

People more likely to become very sick with Covid-19 are those who are older or have certain medical conditions, or who are pregnant and have recently been pregnant. It says people at increased risk, and those who live with or visit them, should talk to a health-care provider about whether they and the people around them should wear a mask or respirator when the Covid-19 community level is medium. Wear a mask or respirator that provides them with greater protection when the Covid-19 community level is high."

For the CDC's complete guidance, including recommendations for children, travelers and disabled people, click here.

The CDC's recommendations are only that, but it has maintained its order that travelers wear masks while using public transportation and indoor transportation hubs. U.S. Sen. Rand Paul of Kentucky said Friday that he would force a vote in the Senate on his resolution to repeal that requirement.

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Senate bill to address the state's nursing shortage passes its first hurdle, but some say it wouldn't do enough

Photo illustration via Nolan Group Media

By Melissa Patrick
Kentucky Health News

A bill to address the nursing shortage in Kentucky passed out of a legislative committee Wednesday, but the state nursing association and several lawmakers said more needs to be done to keep nurses in the profession.

"This is not just related to hospitals, it's related to long-term health-care facilities and anybody else who relies on nursing," Senate President Robert Stivers, a co-sponsor of the bill, told the Senate Health and Welfare Committee. 

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, offers four key measures: licensing reciprocity between other states and nations, higher enrollment caps, looser nursing-instructor qualifications and restructuring the state Board of Nursing.

The panel approved the bill after rewriting it to address issues involving temporary work permits and credentialing requirements for nurses with degrees from foreign nursing schools, and saying a nursing program's students must have an 80% pass rate on the licensure exam over three years, instead of five. 

Delanor Manson, CEO of the Kentucky Nurses Association, told the committee, "Senate Bill 10 and the revisions are going in the right direction, but it doesn't go far enough." She presented a five-point plan that called for spending $100 million in state funds to address the nursing shortage. 

First, she called for repeal of Kentucky's requirement that advanced-practice registered nurses have a collaborative agreement with a physician to prescribe narcotics and some other controlled substances. 

"There are approximately 2000 APRNs who are practicing outside Kentucky because they cannot practice to the full extent of their licensure and experience and education," Manson said. "We need to bring those nurses home."

Manson estimated that other parts of her plan would bring about 1,500 of the 5,000 retired nurses in Kentucky back into the workforce, through education and retraining. It also calls for expanded training through increased faculty salaries and loan forgiveness; recommends a campaign to make sure nurses know they are appreciated; and offers retention bonuses for nurses who stayed in their communities throughout the pandemic.

Several legislators also called for more efforts to keep nurses on the job. 

"I do think the greatest improvement could be if we had some retention money set aside in our budget to really work toward keeping our nurses long term in Kentucky," said Democratic Sen. Denise Harper Angel of Louisville. "But this is an excellent first start." 

Sen. Stephen Meredith, a Leitchfield Republican and former hospital administrator, praised the bill but said, "I'm a little bit concerned that we don't have more focus on the retention side of it. . . I don't think people understand how demanding nursing has become." 

Nancy Galvagni, president of the Kentucky Hospital Association, spoke in favor of the bill, saying the nursing shortage has been building for years and has placed great stress on hospitals. She said hospitals are burning through reserves to hire traveling nurses to fill the gaps, at of $200 to $250 per hour. 

"These expenses are not sustainable and they could easily lead to cuts and services," Galvagni said. "And we know that hospitals are already looking at what services they may need to discontinue." 

Sen. Ralph Alvarado, a physician who works in long-term care facilities, called the situation "dire."

"We have a lot of facilities that are shutting down wings, because they don't have adequate nursing staffing," said Alvarado, R-Winchester. "We know that our hospitals haven't been able to operate at its fullest capacities, because we don't have nursing staff to manage a lot of those wings in our hospitals." 

Democratic Gov. Andy Beshear declared an emergency in mid-December, allowing the state to take special measures to educate and license more nurses.

His order requires the nursing board to approve requests for enrollment increases if a school has sufficient resources; requires schools to report vacant student seats to the board monthly to post online, and send the board a list of needed faculty; allows a school to open new campuses more quickly; and improves reciprocity with other states. Beshear's budget proposal also included scholarship and loan-forgiveness money to attract and retain nurses.

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44 of 120 counties are now out of the high-infection red zone, but Kentucky still ranks high in new cases and hospitalizations

State Dept. for Public Health map, adapted by Kentucky Health News; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

As the Omicron variant's surge in Kentucky wanes, more than a third of the state's 120 counties have moved out of the state infection map's red zone, for counties with high levels of coronavirus infection.

Fulton, Todd and Hickman counties are in yellow on the map, representing a "moderate" level of infection, 10 or fewer daily cases per 100,000 residents in the last seven days. Forty-one counties are in orange, for a "substantial" level, 10 to 25 cases per 100,000; the rest are in red. 

Kentucky reported 2,202 new coronavirus cases Friday, bringing the seven-day average down to 2,346, 38% below what it was a week earlier. Nearly 25% of the day's new cases are in people 18 and younger.

Kentucky's seven-day infection rate is 35.05 daily cases per 100,000, less than half what it was 10 days ago. Counties with rates more than double the statewide rate are Perry, 185.8; Wolfe, 149.7; Leslie, 134.5; Menifee, 116.7; Robertson, 108.4; Knott, 99.4; Letcher, 97.4; Lee, 88.8; Wayne, 83.6; Lawrence, 83.0; Floyd, 80.7; Morgan, 80.5; Owsley, 77.7; Bath, 76.6; Breathitt,75.8; Montgomery, 72; Jackson, 71.8; Clay, 71.8; and Anderson, 71.

Kentucky has the fifth highest infection rate among states, according to to an analysis of Centers for Disease Control and Prevention data in The New York Times. West Virginia ranks sixth and Tennessee ranks eighth.

While Kentucky's infection rank has fallen, the state is No. 2 in hospital patients per 100,000, with Covid-19, trailing only West Virginia in the Times-CDC rankings. Tennessee is third and Missouri is fourth.

Kentucky hospitals reported 1,149 patients with Covid-19 Friday, about half as many as three weeks ago; 223 were in intensive care and 119 on mechanical ventilation, both down by almost half in three weeks.

The state attributed 38 more deaths to Covid-19 Friday, a relatively high number, but the seven-day and 14-day averages of reported deaths are dropping; today they are 27.7 and 32.8 respectively. Kentucky's pandemic death toll is now 13,758.

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UK medical and engineering teams will take new technology for testing wastewater for coronavirus to rural Kentucky this summer

By Elizabeth Chapin

University of Kentucky

Throughout the pandemic, researchers from the University of Kentucky’s College of Medicine and College of Engineering have joined forces to track the virus’ presence in the community by testing wastewater.

The practice has seen limited use in the past as a public-health surveillance tool, but the pandemic has brought newfound interest due to its ability to monitor infection trends without extensive clinical testing, says Dr. James Keck, an assistant professor of family and community medicine.

“The investment in advancing wastewater testing is a reflection of the usefulness of this tool to give a comprehensive picture of the spread of infection, especially in rural communities with limited access to clinical testing,” Keck said.

Keck's partner in two projects that have attracted $4.7 million in federal funding is Associate Professor of Mechanical Engineering Scott Berry, who invented a new technology that uses special beads to extract the RNA shed by the virus to make the process faster and more efficient.

The team’s first project, supported by an 18-month $1.3 million grant from the Centers for Disease Control and Prevention, is focused on testing wastewater from nursing homes.

The team has been testing wastewater daily at six nursing homes in the Lexington and Louisville areas using an automated sampling device. If a sample tests positive, facilities are notified and can take additional measures to prevent spread of the infection, including facility-wide clinical testing.

“Since wastewater testing can show the first signs of an outbreak in a community prior to detection in clinical samples, the early notice could help prevent Covid-19 infections and deaths in this vulnerable population,” Keck said.

The second project, funded by a $3.4 million grant from the National Institutes of Health, is aimed at advancing testing technology so that samples can be processed and analyzed on-site using Berry's exclusion-based sample preparation (ESP) process.

“ESP can provide a fast and simple method to manipulate RNA and has the potential to improve testing sensitivity and help to create a low-cost way to expand testing in rural areas or developing countries,” Berry said. “RNA also degrades over time, so the faster samples can be tested, the more accurate the results.”

Conventional wastewater testing sends to a lab so they can go through a complicated series of steps needed to extract the RNA before a polymerase chain reaction (PCR) test can be done.

With the help of engineering students, Berry and his team created a mobile lab to take wastewater testing to rural Kentucky. Equipped with ESP and loop-mediated isothermal amplification, the “Disease Detective” van has the capability to both process and analyze samples in the field.

Beginning this summer, the van will head to rural communities in Kentucky, where Berry’s team will train people to test wastewater at treatment plants, schools and streams.

In the meantime, Berry's lab is processing weekly samples from wastewater treatment plants from eight counties. Local health officials are using the results to evaluate responses to the spread of infection. The hope is that the ESP technology will eventually allow wastewater treatment plant operators to do the testing, Berry says.

In addition to the training, the team is partnering with UK’s College of Education on another project that will use the mobile lab to teach local students about wastewater testing and get them excited about science, technology, engineering and mathematics.

It’s just another way the project has connected researchers from different disciplines who otherwise may never have worked together, Keck says.

“Basic-science researchers and engineers are working with public-health officials to have real impact in communities across Kentucky,” Keck said. “These projects utilize expertise and resources across many disciplines, bringing UK’s mission as a land grant institution into service.”

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Latest Covid-19 surge seems over in Kentucky, but state still has second highest infection rate among states, well into the red zone

Ky. Health News graph from state data; click on it to enlarge.

By Melissa Patrick
Kentucky Health News

Kentucky's pandemic metrics have largely returned to where they were before the latest surge, but the commonwealth continues to have the second highest coronavirus infection rate among the states. 

Kentucky reported 2,689 new cases Wednesday, bringing the seven-day rolling average to 3,028, down 354 from Tuesday and 26% from a week ago.

The percentage of Kentuckians testing positive for the virus in the last seven days is 10.80%. The last time it was in this range was in late December, before the surge in Omicron variant cases began.

Kentucky's seven-day infection rate is 45.04 daily cases per 100,000 residents, just below where it was just before the surge began. Counties with rates more than double that rate are Perry, 198.6; Wolfe, 185.6; Leslie, 146.1; Lee, 135.1; Letcher, 133.2; Menifee, 125.5; Robertson, 115.2; Owsley, 110; Knott, 104.2; Floyd, 102.8; Montgomery, 97.9; Breathitt, 96.1; McCreary, 94.5; Jackson, 93.2; and Bath, 92.6.

Three Kentucky counties are now yellow on the state infection map, representing a "moderate" level of infection: Hickman, 9.8 cases per 100,000; Fulton, 9.6; and Todd, 8.1. Twenty-five counties are orange, for a "substantial" level, 10.1 to 25 cases per 100,000; the rest are in red, considered a high level. 

Kentucky's infection rate is again second highest among the states, trailing only Idaho, according to The New York Times' analysis of Centers for Disease Control and Prevention data. Only three Kentucky counties are in the top 20 counties nationally, down from 10 a few days ago. They are Perry, 251 cases per 100,000; Morgan, 195; and Floyd, 184. (CDC and state figures differ due to methodologies.)

Kentucky hospitals reported 1,323 patients with Covid-19 Wednesday, 22% lower than a week earlier, with 254 in intensive care and 131 on mechanical ventilation.

Eight of the state's 10 hospital regions are using at least 80% of their intensive-care capacity, with three above 90%. Barren River is the highest, at 96.3%. 

The state reported 25 more Covid-19 deaths. The seven-day Covid-9 death average is 29.57; the 14-day average is 33.78. Kentucky's pandemic death toll is now 13,689.

The Washington Post reports that in the past seven days, Kentucky saw an 11% increase in the number of Covid-19 vaccine doses given over the week before, with 5,260 doses per day administered. However, the daily average four days ago was 6,377. 

The state says 2.9 million Kentuckians have received at least one dose of a vaccine, or 64% of the total population; 2.5 million are fully vaccinated, or 56% of the population; and 1 million have been boosted, or nearly 43% of the those who are fully vaccinated. 

On Tuesday, the CDC issued new Covid-19 vaccine guidance for the Pfizer-BioNTech and Moderna vaccines to expand the recommended time between the initial two vaccine doses to eight weeks for some people 12 and older, especially for males between 12 and 39. 

This new recommendation was issued because to reduce the risk for severe side effects, like myocarditis, a heart inflammation that has shown up mostly in young men. Most patients who have developed myocarditis after getting a vaccination have fully recovered, according to the CDC. 

"mRNA Covid-19 vaccines are safe and effective at the FDA-approved or FDA-authorized intervals, but a longer interval may be considered for some populations," the CDC said. "While absolute risk remains small, the relative risk for myocarditis is higher for males ages 12-39 years, and this risk might be reduced by extending the interval between the first and second dose."

The original three-week interval between doses for the Pfizer vaccine and four weeks for the Moderna is still recommended for individuals who are immunocompromised, over 65 or in need of rapid protection against the coronavirus. Covid-19 booster guidance remains the same. 

Despite the potential side effects, the CDC maintained that the benefits of the mRNA Covid-19 vaccines outweigh the small risk of myocarditis.

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House passes bill to add incentives and expand Rural Hospital Loan Program to include closed hospitals that reopen

Graphic from Gov. Andy Beshear's December press conference

By Melissa Patrick
Kentucky Health News

A bill to update the Kentucky Rural Hospital Loan Program to add incentives and include some closed hospitals has passed unanimously in the House and is in the Senate for further consideration. 

House Bill 364, sponsored by Rep. Danny Bentley, R-Russell, builds on 2020 HB 387, which created a revolving loan fund for distressed rural hospitals, and 2021 funding of $20 million.

The original bill, also sponsored by Bentley, allows the Cabinet for Economic Development to provide loans to struggling hospitals to maintain or upgrade facilities; maintain or increase staff; or provide health services not currently available. The loans can run 20 years and are available to hospitals in counties with fewer than 50,000 people.

So far, Pineville Community Health Center is the only hospital to be approved for a loan from the Kentucky Rural Hospital Loan Program. It received a $1 million loan at 1% over a five-year term in December to be used for operating expenses. 

HB 364 would expand the type of rural hospital that would qualify for a loan to include a "qualifying former hospital," or one that closed within 36 months prior to submitting its loan application that also has a certificate of need to open or reopen the facility.  

Five rural hospitals have closed in Kentucky since 2009, four since 2014. The most recent was Our Lady of Bellefonte Hospital in Russell, Bentley's hometown; it closed in April 2020. 

Rep. Danny Bentley

At the Feb. 17 House Health and Family Services Committee meeting, Bentley said Bellefonte is planning to repurpose its facility to include a psychiatric hospital that includes a "detox center" and space to "rehab residents. . . . I had to repurpose the bill, because they are repurposing the hospital." 

HB 364 would also provide an incentive for rural hospitals to be able to get as much as half 50% of a loan forgiven. It would require a maximum amount of $20,000 to be forgiven for each job retained or each new, full-time job created that meets certain wage requirements. 

The bill also provides that hospitals in a chain would be considered separately for the purposes of determining eligibility and loan limits. An emergency clause in the bill would make it take effect immediately. 

A 2020 report from the Kentucky Hospital Association said "anywhere from 16 to 28" of the state's 68 rural hospitals were at risk of closing. A separate analysis in 2021 by the Center for Healthcare Quality and Payment Reform found that 16 of the 69 Kentucky hospitals it considered rural were at risk of closing.

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Herd immunity from Covid-19? Not likely. Herd resistance? Yes.

A recent report estimated that 73 percent of Americans have immunity to the coronavirus, either from being infected by it or by getting vaccinated against it. That has made some people say that the nation is approaching "herd immunity," which protects unvaccinated people by making it more difficult for the virus to circulate.

That's unlikely, experts say. But they do think the highly contagious Omicron variant has spread so widely that it provided "enough protection against the coronavirus that future spikes will likely require much less — if any — dramatic disruption to society," reports Carla K. Johnson of The Associated Press.

“Herd immunity is an elusive concept and doesn’t apply to coronavirus,” Dr. Don Milton at the University of Maryland School of Public Health told Johnson.

"Early hopes of herd immunity against the coronavirus faded for several reasons," Johnson writes. "One is that antibodies developed from available vaccines or previous infection dwindle with time. While vaccines offer strong protection against severe illness, waning antibodies mean it's still possible to get infected — even for those who are boosted."

Also, vaccination has slowed, many areas still have low vaccination and booster-shot rates, and children under 5 still aren't eligible to be vaccinated, Johnson points out.

Finally, "As long as the virus spreads, it mutates, helping the virus survive and giving rise to new variants," Johnson notes. "Those mutants, such as Omicron, can become better at evading the protection people have from vaccines or an earlier infection."

Milton told Johnson that we are moving toward “herd resistance,” in which there is enough protection that outbreaks will be smaller and not disrupt society as the previous surges.

"Many scientists believe Covid-19 will eventually become like the flu and cause seasonal outbreaks but not huge surges," Johnson reports.

Ali Mokdad, a professor of health metrics sciences at the University of Washington, calculated the 73% immunity figure at the Johnson's request. 

"I am optimistic even if we have a surge in summer, cases will go up, but hospitalizations and deaths will not,” he said.

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Most Covid-19 numbers in Kentucky continue to trend down, but our infection rate still ranks second among the states

Ky. Dept. for Public Health map, adapted by Ky. Health News; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

New coronavirus cases and the percentage of people testing positive for the virus in Kentucky keep declining in Kentucky, but it still ranks second among the states for its seven-day rate of daily new cases.  

Kentucky reported 3,300 new cases Tuesday, bringing the seven-day rolling average to 3,382, down 25 percent from a week earlier. The share of Kentuckians testing positive for the virus in the past seven days is 12.18%; it has declined for 30 days in a row since hitting a high of 33.1%. 

The statewide infection rate is 49.71 cases per 100,000 people. Counties with rates more than double that rate are Perry, 197.4; Leslie, 169.2; Lee, 150.5; Floyd, 123.6; Menifee, 121.1; Letcher, 120.0; Wolfe, 117.8; Breathitt, 107.5; Owsley, 106.8; Knott, 106.1; Bath, 102.9; and Lawrence, 99.8.

Kentucky has the second rate among states, according to an analysis of Centers for Disease Control and Prevention data by The New York Times. Idaho's rate is highest; West Virginia is fifth and Tennessee is eighth.

Kentucky hospitals reported 1,384 patients with Covid-19, up 51 from Monday; an increase is typical for Tuesdays, which reflect admissions on Mondays. The seven-day average of Covid-19 patients is 1,485 per day, 24% lower than a week earlier.

Hospitals reported 260 Covid-19 patients in intensive care, down 10 from Monday, and 138 on mechanical ventilation, down three. 

Seven of the state's 10 hospital regions are using at least 80% of their intensive-care beds, with two of them over 90%. Covid-19 patients make up between 12.2% and 30.3% of the capacity. 

The state attributed 17 more deaths to Covid-19, the lowest daily report in weeks. The expectation is that as case numbers decline, deaths will too, but because deaths are a lagging indicator, they remain high. The seven-day Covid-19 death average is 30.6; the 14-day average is 34.4. Kentucky's pandemic death toll is now 13,664.

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Kentucky's infection rate remains top among states, even as almost every metric used to measure the pandemic trends down

By Melissa Patrick
Kentucky Health News

Even as Kentucky's daily case rate, infection rate, positivity rate and hospital rates are steadily trending down, Kentucky's coronavirus-infection rate continues to be the highest among states. 

Gov. Andy Beshear reported that Kentucky's weekly case numbers and positivity rates have now declined for four straight weeks. 

"This is really good news," he said at his weekly pandemic press conference. "We're heading in the right direction." 

In the Monday-to-Sunday reporting week ended Feb. 20, Kentucky reported 25,173 Covid-19 cases, down from 35,961 the prior week. Beshear said this is the lowest number of weekly cases in two months and is now below the Delta variant peak. He added that the hope is that Kentucky will drop to cases levels that were seen between the Alpha and Delta variant, when the state was reporting around 1,000 cases per week.

In the same reporting week, the average test positivity rate dropped to 13.10%. 

Asked if he has considered moving his new recommendations up from March 14, especially with the Senate proposing that the state of emergency end on March 7, Beshear said that ending the state of emergency would have no impact on the need  him to provide guidance and that while the trends could support the need for earlier changes, at this time his best prediction for the new guidance remains March 14. 

Beshear continued to caution that while things are headed in the right direction, case numbers and the positivity rate are still too high. He urged Kentuckians to be patient just a bit longer, especially schools who are under pressure to make mask wearing optional. 

"I would ask that everybody who can, be patient for the next couple of weeks because right now with the level that we're at and the low vaccination rates, I don't believe it's fully safe to go mask optional," he said. 

At this time, only 51% of 16-17-year-olds, 48% of 12-to-15-year-olds, and 21% of 5-to-11-year-olds have received at least one dose of a vaccine. 

From Saturday to Monday, the state reported 5,955 new coronavirus cases, bringing the seven-day rolling average to 3,489, down 276 from Friday. 

Of the 969 new cases reported Monday, which is the lowest number of daily cases since late December, nearly 20% are in people 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days also dropped again, to 12.74%. This rate was 14.34% on Friday and 33.1% a month ago. 

In response to a question, Beshear said that the current trends give us hope that we are moving from a pandemic to an endemic, meaning that the virus will have stopped being widespread, but instead remain present, but limited to particular regions. He also cautioned that it is hard to predict since this virus has "thrown us a lot of curveballs before." 

Kentucky's weekly hospital numbers also continue to decline. On Monday, the hospitals reported 1,333 Covid-19 patients, with 270 of them in intensive care and 141 on mechanical ventilation. 

Six of the state's 10 hospital regions are using at least 80% of their intensive care unit capacity, with three of them above 90%. The percentage of Covid-19 patients in the ICUs range from 6.6% to 29.2%. 

The state's infection rate is now 52.53 cases per 100,000 people. Counties with double that case rate are: Perry, 196.9; Lee, 167.9; Leslie, 163.4; Wolfe, 129.7; Breathitt, 126.7; Floyd, 121.2; Menifee, 118.9; Owsley, 116.5; Knott, 114.8; Letcher, 114.7; Carter, 112.5; Powell, 112.1; and Whitley, 108.7.

Two counties are now in the "yellow zone" on the state's infection map, considered a moderate level of infection: Fulton, with 7.2 cases per 100,000 and Hickman, with 6.5. Nineteen counties are in the "orange zone," considered a substantial level of infection and the  rest are in the "red zone," considered a high level of infection.  

Kentucky continues to have the highest infection rate among states, even with a 31% drop in cases in the last 14 days, according to The New York Times. A Times analysis of infection rates in individual counties, using Centers for Disease Control and Prevention data, shows that Kentucky has 10 of the top 20 counties for this measure. They include Perry, Estill, Floyd, Butler, Morgan, Clay, Breathitt, Carter, Whitley and Boyle. 

The only metric that remains high in Kentucky is Covid-19 deaths, a lagging indicator that Beshear said he hopes will soon show a decline. From Saturday to Monday, the state reported 82 more Covid-19 deaths reported, with two of them in their 30s and four of them in their 40s. Kentucky's pandemic death toll is now 13,647. 

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Tobacco levies a toll of disease and death in Kentucky; health advocates say state government needs to do a lot more about it

As the state legislature ponders allowing local governments to again regulate tobacco sales, the Lexington Herald-Leader has produced a comprehensive report showing the damage done to Kentucky's health by the crop that once accounted for almost half the state's farm income – and politicians' unwillingness to do much to limit the damage.

"The state’s response has been among the most anemic in the country, tobacco control advocates say. The state spends a fraction of what’s recommended to prevent people from starting to smoke and help smokers quit, and its tax rate on cigarettes is among the lowest in the country," Bill Estep reports.

High-school students in Kentucky smoke more than in any other state, 8.9 percent of them, according to the American Lung Association. The adult smoking rate, 21.4 percent, is the nation's second highest, trailing only West Virginia's 22.6%; the national rate is 14%. In Monroe, Metcalfe and Wolfe counties, the adult rate is 45%, 44% and 42%.

Kentucky's lung-cancer rate of 88 annual cases per 100,000 residents is the highest in nation; the U.S. rate is 57. The state also has the highest death rate from lung cancer.

The Campaign for Tobacco-Free Kids estimates that 8,900 Kentucky adults die each year due to smoking, "and that health-care costs tied to smoking total $1.92 billion a year, not counting any impact from secondhand smoke," Estep reports. "The organization said nearly $600 million of that spending is through Medicaid, a taxpayer-funded program. The state and federal tax burden per household in Kentucky from smoking is $874."

But the tobacco industry usually wins in Frankfort. In the mid-1990s, the General Assembly prohibited cities and counties "from having their own rules on the use, display, sale and distribution of tobacco products," Estep notes. "The law means communities can’t limit the visibility of cigarettes in convenience stores, for example, or prevent vape shops from locating close to schools."

Sen. Wil Schroder

The ban would be repealed by Senate Bill 166, filed by Sen. Wil Schroder, a Northern Kentucky Republican. The tobacco industry is against it. David B. Sutton, a spokesman for Altria Group, the nation's leading cigarette maker, "said the state should avoid a confusing patchwork of local rules and taxes," Estep reports. Sutton said a varying rulebook “makes operating a business more complex and confusing for retailers trying to operate within the bounds of the law.”

Last year, when two similar bills were introduced, "Supporters had counted heads and thought they had the votes to pass the bills," Estep wrotes. "But the bills died a quick death. They didn’t get a hearing, much less a vote. Altria, a leading tobacco company, spent $73,627 on lobbying in the first three months of the legislative session as two bills were bottled up in committee."

As in many other states, the legislature has also refused to spend more money on tobacco cessation and prevention programs, keeping the about at $2 million a year. The state gets tobacco-related revenue of almost $500 million a year, and the Centers for Disease Control and Prevention recommends that it should spend $56 million of it to help people quit and keep others from starting.

The Foundation for a Healthy Kentucky estimates the tobacco industry spent $246 million in 2020 in Kentucky promoting its products, Estep notes.

It all adds up to a need to act on many fronts, said University of Kentucky nursing professor Ellen Hahn, director of a project called BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) that has led anti-tobacco efforts in the state.

“Tobacco’s an addiction. It’s really rampant across Kentucky, so to fix it we need every tool in the toolbox,” Hahn told Estep. “If local communities have their hands tied and they can’t pass rules for instance that make it harder for youth to purchase tobacco products, it just limits our ability to fix the problem.”

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Had Covid-19? You're 60% more likely to have mental illness, study finds; researcher says it shows disease isn't 'like the flu'

Los Angeles Times photo

People who've had Covid-19 have a 60 percent higher chance of experiencing mental health problems, including anxiety, depression, and thinking of suicide, as well as drug and alcohol abuse and disturbances in sleep and cognition.

The results come from a study by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Using anonymous data from the VA, the nation’s largest integrated health-care delivery system, the researchers compared the mental-health outcomes of more than 150,000 patients who had mild or severe Covid-19 cases from March 1, 2020 to January 15, 2021, with the outcomes of two control groups: one of more than 5.6 million patients who did not have Covid-19 during the same time period, the other of more than 5.8 million people who were patients from March 2018 to January 2019, well before the pandemic. The study is published in the BJM (British Medical Journal).

People diagnosed with Covid-19 were 60% more likely to suffer from mental-health problems than those who were not infected, leading to an increased use of prescription medication to treat such problems and increased risks of substance-use disorders including opioids and non-opioids such as alcohol and illicit drugs, the study found.

“People need to know that if they have had Covid-19 and are struggling mentally, they’re not alone, and they should seek help immediately and without shame,” said Ziyad Al-Aly, the study's lead author. “It’s critical that we recognize this now, diagnose it and address it before the opioid crisis snowballs and we start losing more people to suicide.”

Al-Aly continued, “Our findings suggest a specific link between SARS-Co-V-2 [the novel coronavirus] and mental-health disorders. We’re not certain why this is, but one of the leading hypotheses is that the virus can enter the brain and disturb cellular and neuron pathways.”

To better understand whether the increased risk of mental-health disorders is specific to Covid-19, the researchers also compared the Covid-19 patients with 72,207 flu patients, including 11,924 who were hospitalized, from October 2017 through February 2020. Again, the risk was significantly higher in those who had mild and serious Covid-19 infections.

“My hope is that this dispels the notion that Covid-19 is like the flu,” Al-Aly said. “It’s so much more serious.” He stressed the importance of identifying and treating mental-health disorders in Covid-19 survivors.

“Our goal was to provide a comprehensive analysis that will help improve our understanding of the long-term risk of mental-health disorders in people with Covid-19 and guide their post-infection health care,” added Al-Aly. “Studies on Covid-19 and mental health have been limited by a maximum of six months of follow-up data and by a narrow selection of mental-health outcomes; for example, examining depression and anxiety but not substance-use disorders.”

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Bill aims to ease Kentucky's nursing shortage by relaxing licensing and instruction requirements, enrollment caps

By Melissa Patrick
Kentucky Health News

A state Senate committee plans to hear a bill Wednesday to address the nursing shortage in Kentucky, which has been exacerbated by the pandemic. 

Sen. Robby Mills

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, offers four key measures to address the shortage: licensing reciprocity between other states and countries, higher enrollment caps, looser nursing-instructor qualifications and restructuring the state Board of Nursing. If passed, it would become effective immediately. "I think it's going to do away with some of the kind of obstacles that are there to keep folks from getting into the nursing profession and getting into work quicker and faster as they're needed," said Mills.

The bill is scheduled to be heard at 10 a.m. ET Feb. 23 by the Senate Health and Welfare Committee.

Mills and Senate President Robert Stivers announced the bill Feb. 15, calling it priority legislation. They were joined by Sens. Ralph Alvarado of Winchester and Donald Douglas of Nicholasville, both physicians and Republicans. 

"I think we've come up with a good product, working with various institutions and entities and discussing with the public how we increase the nurses in this state to help provide medical services," Stivers said.

Asked what ensures that the state's nursing programs will maintain their quality as they are allowed to increase their enrollment, Stivers said that will be accomplished by requiring schools to only be able to increase enrollment if they maintain at least an 80% average rate of students who pass their licensure exam.

The bill would expand the qualifications for who can be an nursing instructor, allowing a nurse with a bachelor's degree to teach in a bachelor's-degree program as long as they are pursuing their master's degree, and allow licensed nurses from other countries to practice in Kentucky, with some testing requirements.

It also would allow the nursing board to immediately issue temporary work permits and licenses to nurses who are licensed in other states outside the state's existing compact with 23 other states, as long as they are in good standing. Similar rules are included for licensed practical nurses.

The bill would restructure the board to require two members from each of the state's six congressional districts, with no more than six of the members being nurse educators, each of those appointed from a different district. All other nurse members of the board are required to be practicing nurses. It also limits members to three four-year terms. 

Mills said they had talked to "multiple folks in the health-care field" in drafting the bill. He added that it is a "live" piece of legislation will likely require some "give and take" going forward, noting that the nursing board had already made some suggestions for change. The nursing shortage was also discussed at length during an Interim Joint Committee on Health, Welfare and Family Services. 

The Kentucky Nursing Association CEO Delanor Manson told Kentucky Health News, "The KNA was not contacted prior to the filing of SB10."

The KNA projects that the state will need more than 16,000 additional nurses by 2024, to replace those who will retire or leave the profession, as many have in the pandemic. A CBS News report Friday night, focusing on St. Claire Regional Medical Center in Morehead, said 40% of the hospital's nurses have quit during the pandemic.

Gov. Andy Beshear declared an emergency in mid-December to allow the state to take special measures to educate and license more nurses. 

His executive order requires the board to approve requests for enrollment increases if a school has sufficient resources to do so; to report vacant student seats to the board each month to post online; requires nursing schools to send the board a list of needed faculty; increases the speed in which a school could open new campuses; and improves reciprocity between states. Beshear's budget proposal also included scholarship and loan-forgiveness money to attract and retain nurses. 

The governor has also formed a "Team Kentucky Nursing Advisory Committee" that meets virtually to discuss the challenges contributing to the nursing shortage in Kentucky and potential solutions. Its next meeting is set for at 4 p.m. ET Feb. 21.

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Bill would allow a year of Medicaid for new mothers, almost 1/2 of whom don't get routine care in Ky., where death rate is highest

By Melissa Patrick
Kentucky Health News

A bill that would extend Medicaid coverage to new mothers up to 12 months after giving birth passed unanimously out of the House Friday and now heads for the Senate for consideration. 

Rep. McKenzie Cantrell

House Bill 174, sponsored by Rep. McKenzie Cantrell, D-Louisville, would extend Medicaid eligibility for persons who have given birth for up to 12 months postpartum. It also requires the Cabinet for Health and Family Services to seek a Medicaid waiver to achieve this additional coverage if necessary. 

Cantrell told the House that the small addition that the bill would make to state law "is a seven-word change that can have a huge impact on women and families in our commonwealth." 

Rep. Kim Moser, R-Taylor Mill, co-sponsor of the bill, told the House that the United States is the only industrialized nation that has a consistently rising maternal mortality rate, and Kentucky's rate is the highest. 

"Kentucky has rates of maternal death that really rival Third World countries," Moser said. "We have 37.7 maternal deaths per 100,000 live births, which is the highest in the nation." 

Rep. Lisa Willner, D-Louisville, added that nationwide, 60% of pregnancy-related deaths are preventable, but in Kentucky, 80% are. Willner is chair of the House Democratic Women's Caucus, which created the Kentucky Maternal and Infant Health Project that includes a slate of bills and resolutions to improve maternal health outcomes. 

"This is one step toward preventing those complications from pregnancy," she said, "and there are many more steps we can take."

In an e-mail encouraging Kentuckians to sign a letter of support for the bill, Kentucky Voices for Health explains that the expanded coverage is possible through the American Rescue Plan Act, the pandemic relief bill Congress passed a year ago. It allows postpartum care to go from 60 days to a full year following the birth of a child for mothers with incomes up to or slightly higher than 138% of the federal poverty level. That is the limit for Medicaid coverage. 

KVH said, "This is important because about one in three pregnancy-related deaths occur one week to one year after delivery. Of those deaths, three in five are preventable and the ratios of pregnancy related deaths among people of color are up to five times higher than white birthing people."

Kentucky Youth Advocates Executive Director Terry Brooks said, "Despite the increased risk of postpartum death and illness, nearly half of women do not receive routine care after birth, regardless of whether or not they experienced complications during pregnancy. HB 174 is good news for the health and well-being of new moms and their babies."

The bill also has the support of the Kentucky Association of Health Plans, the insurance companies doing business in the state, including Medicaid managed-care companies.

“Postpartum depression affects a significant portion of new mothers, and when left untreated is one of the leading causes of pregnancy-related death. Kentucky’s Medicaid managed-care organizations are well-positioned to ramp up outreach and connect moms to supports services that can change and save lives,” KAHP Executive Director Tom Stephens said in a statement issued after the bill passed out of committee.

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