Health officials in counties with high and low Covid-19 death rates point to vaccination rates, residents' underlying health status

Kentucky Health News map via Datawrapper, highlighting high-death-rate counties of Metcalfe, Monroe, Harlan, Perry, Lee and Robertson, and low-death-rate counties of Jefferson, Fayette, Scott and Woodford. For an earlier story with an interactive map with all counties' rates and data, click here.

By Melissa Patrick
Kentucky Health News

Health officials from Kentucky counties with some of the state's highest and lowest Covid-19 death rates both cited vaccination rates as a contributor, but the health official in the county with one of the highest death rates said the relatively low health status of the population must also be considered. 

A breakdown of Covid-19 deaths per 1,000 people in each county found that the highest county death rate is five times the lowest one. To explore that discrepancy, Kentucky Health News talked with a health official in a county with one of the highest rates, and one in a county with one of the lowest rates. 

In Woodford County, which had the fourth lowest rate, 2.09 Covid-related deaths per 1,000 residents, Public Health Director Cassie Prather said she attributed the low rate to its high Covid-19 vaccination rates, especially among residents 65 and older, who are among the most vulnerable.

"I would love to see a map overlay of the death rates and the vaccine rates," she said. Later adding, "I think the correlation is there." 

Woodford County has had one of the highest vaccination rates in the state throughout the pandemic. According to the Centers for Disease Control and Prevention Data Tracker, 78.3% of Woodford County's population has received at least one dose of the Covid-19 vaccine. Among residents 65 and older, 93.3% are fully vaccinated; 73.3% of those who are fully vaccinated have received one booster shot; and 54.6% of  those who have had the first booster have also received the second. 

Cassie Prather

Prather said getting people in Woodford County vaccinated has been a community effort that includes weekly clinics that are still running, community members volunteering to drive people to the clinics, a partnership with the emergency medical service to do home visits, and a mobile clinic that goes out twice a week to farms and people they normally wouldn't see at the health department. 

She added that city and county governments have worked diligently to keep their citizens informed, and that she and Judge-Executive James Kay still do weekly Covid-19 updates on the county government's Facebook page. "We knew how important communication would be . . . because we wanted people to be aware and to be able to make the best decisions for their family and friends," she said. 

Kay, who as judge-executive chairs the county health board, said his pandemic role has been to unite the community in an effort to fight the virus, while allowing the health department to lead the response. 

"We did a full county and community response," Kay said. "And we brought the cities and the county and the schools together to all be on the same page every day for nearly two years."

Expanding on the importance of giving the public direct, real-time information to combat misinformation, he said, "We created a level of trust. When we told them information; they knew it was true."  

Adjoining Scott County's Covid-19 death rate was just .007 per 1,000 higher than Woodford's. Crystal Miller, public health director of the regional health department that serves the county, told Mike Scogin of the Georgetown News-Graphic that the community's response to the pandemic was critical to keeping Covid-19 under control. 

“It was all hands on deck,” Miller told Scogin. “All our community partners bought in and everyone contributed. From elected leaders to businesses and industries, the hospital, schools and the newspaper, everyone wanted to do the right thing. A big portion was community support. The calls we received at the health department were, ‘How can we keep people safe?’”

Miller also said Scott County has one of the state's highest vaccination, which saved lives. The CDC says 65.2% of the county's population has received at least one dose of Covid-19 vaccine. 

“We did not get a lot of pushback," Miller said. "I know that was not the case in other communities, where people refused to even wear masks."

Metcalfe County, in south-central Kentucky, had the sixth highest Covid-19 death rate, 7.348 per 1,000 residents. It is served by the Barren River District Health Department, where Public Health Director Matt Jones said he thinks the rate stems from multiple factors.

Jones cited the county's poor health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians, tobacco use, children living in poverty, and other environmental factors that contribute to or detract from the local population's health. 

"Those health outcomes, those health factors, they were already at play," he said. "And I think that is one of the leading reasons why we had higher mortality rates in Metcalfe County and the other six counties that you listed."

Counties with death rates higher than Metcalfe were Lee, 7.565; Perry, 7.803; Monroe, 8.075; Harlan, 8.574; and Robertson, the state's smallest county, 10.436 deaths per 1,000 residents.

Comparing just Metcalfe and Woodford counties' 2022 County Health Rankings, Metcalfe ranked 71st for health outcomes and 89th for health factors and Woodford County ranked eighth for health outcomes and third for health factors. 

Eight of the top 10 counties with the lowest Covid-19 death rates in Kentucky ranked in the top 11 counties for health outcomes, and included the top six counties for health factors.

"ZIP code matters," Jones said. 

Among the seven counties with the highest Covid-19 death rates, all ranked 69th or lower for health outcomes, and four ranked in the bottom 11. All seven ranked 64th or lower in health factors, with three in the bottom six. 

Jones also pointed to the discrepancies in health-care access between rural and urban counties as a possible reason for Metcalfe County's higher Covid-19 death rate.

He noted that Warren County, which has a population of nearly 133,000, and Metcalfe, with around 10,000, have very similar vaccination rates, 45.7% and 45.3%, respectively, with at least one dose, but Warren's death rate was less than half Metcalfe's, 3.02 deaths per 1,000 residents. 

Warren, with its fast-growing county seat of Bowling Green, has many more health resources than Metcalfe County, including two hospitals, while Metcalfe County has no hospital and a shortage medical providers, Jones noted.  

Asked about the county's lower vaccination rates, he said, "I think vaccinations did play a role, especially as it relates to moderate and severe cases. But I do think those health outcomes and the other indices played a major role in the overall outcomes of Covid." 

Among Metcalfe County seniors, 62.7% are fully vaccinated; 67.8% of those have received one booster shot; and 36% of that group have taken the second shot, according to the CDC.  

Jones said the eight counties in his health district have taken a multifaceted approach to the pandemic that has evolved as their needs have evolved. Beyond providing testing and Covid-19 vaccination clinics, the local departments participated in work groups with community leaders to keep them informed and used social media, local newspapers and radio stations to keep the public informed.

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The risk of Covid-19 infection in Kentucky is increasing, with a big jump in counties moving from low to medium risk last week

Centers for Disease Control and Prevention map

By Melissa Patrick
Kentucky Health News

The risk of Covid-19 transmission increased across the state last week, with the latest federal risk map showing 63 Kentucky counties at either high or medium risk, up from 30 on the prior week's map. 

The Centers for Disease Control and Prevention map, which looks at both cases and hospital data to determine risk, shows seven Kentucky counties at high risk, shown in orange; 56 at medium risk, shown in yellow; and 57 counties at low risk, shown in green.

Most of the shifts from the prior week's map were among counties that moved from low risk to medium risk, with 37 fewer green counties on the latest map and 30 more yellow ones. The number of red counties increased by three on the latest map.  

Counties at high risk are Mercer, Greenup, Carter, Boyd,  Letcher and Pike. Letcher is the only red county on the latest map that was also red on the last two reports. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC also has a transmission-level map that shows the level of virus spread in each county, at one of four levels. Carlisle and Hickman counties have a moderate level of transmission. The map shows McCracken, Lyon, Christian, Owen, Pendleton, Nicholas and Elliott have substantial levels of transmission and the rest of the counties have a high level of transmission. This data is largely used by researchers and health-care facilities. 

State health officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures. 

The New York Times ranks Kentucky's infection rate 17th among states, with a 52% drop in cases in the last two weeks. 

At his weekly news conference Thursday, Gov. Andy Beshear said it will be important to watch Covid-19 over the next few weeks, noting that while the most recent surveillance continues to be encouraging, cases went up last week, and the prior week's risk map had a few more red counties than the week before. The good news, he said, is that hospital numbers remain low. 

"I think we've got to wait 'til future weeks to determine what that means, if anything," he said. 

Beshear also encouraged Kentuckians to get vaccinated and boosted if they want these numbers to stay low, cautioning that cold weather and the holidays are coming, a time when people will gather indoors where it is easier for the virus to spread. 

"First, if you haven't gotten vaccinated, I know you've waited a long time. Just please consider doing it. . . . Here's the other thing. We need a lot more people to get the new booster, the Omicron booster. It protects you not only from the current strains that are out there, but the strains that we're hearing about in Europe and elsewhere. This booster appears to be effective for it," he said. " Right now, if you are vaccinated and boosted your chances of ending up hospitalized or worse, losing your life, are negligible."

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Don't forget to turn your clock back one hour Nov. 5-6; sleep experts say standard time is the better one for health and safety

Cincinnati Enquirer photo

By Melissa Patrick
Kentucky Health News

It's almost time to "fall back" one hour into standard time, which sleep specialists say is better for our health because it more closely matches our body's internal clock. Standard time officially begins on Sunday, Nov. 6. 

“Daylight saving time disrupts the body’s natural circadian rhythms and impacts sleep,” Jennifer Martin, president of the American Academy of Sleep Medicine, said in a news release. “Standard time provides a better opportunity to get the right duration of high-quality, restful sleep on a regular basis, which improves our cognition, mood, cardiovascular health, and overall well-being.”

Why is standard time better for our health? "The daily cycle of natural light and darkness is the most powerful timing cue to synchronize our body’s internal clock," Martin says. "When we receive more light in the morning and darkness in the evening, our bodies and nature are better aligned, making it easier to wake up for our daily activities and easier to fall asleep at night. Daylight saving time disrupts our internal clock, leading to sleep loss and poor sleep quality, which in turn lead to negative health consequences." 

Polling shows that most Americans want to stop changing their clocks twice a year, and the U.S. Senate has unanimously passed legislation (without debate) to do just that. But it wants the national, fixed, year-round time to be daylight saving time. 

The bill, called the Sunshine Protection Act, is stalled in the House. But as the House considers the legislation, the sleep-medicine academy has implored its members to evaluate the evidence that supports the adoption of year-round standard time. 

The academy argues that in addition to matching our body's internal clock, standard time means more light and thus safety in mornings, especially for commuters and children heading to school. It says daylight time disproportionately affects those in the northern part of the country because of late sunrise times, especially in the winter. The academy also points to studies that show that seasonal time changes are risky to people's health.

The academy also notes that Congress tried permanent daylight time in 1973 to reduce energy consumption, but reverted back to standard time eight months into the two-year plan due to massive complaints. 

“By eliminating the seasonal time change and adopting standard time permanently on a national scale, we can all reap the benefits of better overall health and an enhanced sense of safety for ourselves and our families," Martin concluded. 

An Associated Press poll last fall found that three-fourths of Americans supported having the same time year-round, but they were divided on which one, with 43% saying standard time and 32% daylight time.

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Exposure to electronic-cigarette aerosols cause irregular heartbeats in mice, University of Louisville researchers report

 Mathew Nystoriak, associate professor of medicine,
watches assistant professor Alex Carll. (UofL photo)

By Melissa Patrick
Kentucky Health News

Exposure to electronic-cigarette aerosols can cause heart arrhythmias in mice — in both premature and skipped beats, according to a University of Louisville study. 

Published in the peer-reviewed scientific journal Nature Communications, the study suggests that exposure to specific chemicals in e-cigarette liquids promote irregular heartbeats and cardiac electrical dysfunction, which could increase the risk for atrial or ventricular fibrillation and heart attacks. 

“Our team’s findings that specific ingredients in e-cigarette liquids promote arrhythmias indicates there is an urgent need for more research into the cardiac effects of these components in both animals and humans,” lead researcher Alex Carll, an assistant professor in the UofL Department of Physiology, said in a news release.

The researchers looked at the cardiac effects of inhaled aerosols generated from e-cigarette liquids with and without nicotine . 

"For all e-cigarette aerosols, the animals’ heart rate slowed during puff exposures and sped up afterwards as heart rate variability declined, indicating fight-or-flight stress responses," they write. "In addition, e-cigarette puffs from a menthol-flavored e-liquid or from propylene glycol alone caused ventricular arrhythmias and other conduction irregularities in the heart." 

The study was conducted in collaboration with Daniel Conklin and Aruni Bhatnagar, professors in the UofL Division of Environmental Medicine. 

"The findings are important because they provide fresh evidence that the use of e-cigarettes could interfere with normal heart rhythms — something we did not know before," Bhatnagar said in the release. "This is highly concerning given the rapid growth of e-cigarette use, particularly among young people."

The release said the research adds to a growing body of knowledge on the potential toxicity and health impacts of e-cigarettes reported by the American Heart Association Tobacco Regulation and Addiction Center, for which UofL serves as the flagship institute.

This research contributes to the ongoing debate of whether e-cigarettes are safer to use than combustible products.

For example, the release notes that while vaping does not involve combustion, thus exposing users and bystanders to little if any carbon monoxide, tar or cancer-causing nitrosamines like traditional cigarettes, e-cigarettes can deliver aldehydes, particles and nicotine at levels comparable to combustible cigarettes. 

Proponents of e-cigarettes contend that vaping helps smokers quit smoking traditional cigarettes, but the appeal of the products and their addictiveness have led to increases in youth vaping, even as the long-term risks of the products have not yet been determined.

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What to know about RSV, the virus that can cause serious illness in infants and the elderly: for one thing, keep them hydrated

By Hilary Brown
University of Kentucky

Respiratory syncytial virus is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. Pediatricians across the country are seeing a significant increase in RSV in children.

Lindsay Ragsdale, M.D.

Dr. Lindsay Ragsdale, chief medical officer for Kentucky Children’s Hospital, answers some questions about RSV and what she and other providers are seeing in Kentucky.

What is RSV? RSV is a respiratory virus with cold-like symptoms. The most common symptoms are runny nose, feeling rundown with some fever and cough. Most kids can fight it off with their immune systems like they would a cold. Others could require hospitalization because their airways are smaller, or they have an underlying medical condition such as lung or heart issues or other problems where their immune system isn't as strong. Those who are hospitalized need more intensive interventions, such as frequent suctioning, supplemental oxygen or other respiratory support.

Why is there an increase in RSV this year? We think it's because during the pandemic, we were social distancing and masking, so the germs really didn't get spread around. Our hypothesis is that kids under 2 years of age have never been exposed to RSV, or were exposed rarely. And now they're all getting exposed at once. We started seeing RSV in May, which is unheard of — it is normally a January to March illness. So that seasonal winter spread is not happening. We're seeing it now more than ever.

What symptoms should parents and caregivers look for? When kids get congested, they don't really drink or eat very well, so it’s important for them to stay hydrated. Parents can watch for enough wet diapers, or if their child is making tears when they cry. And the other thing to watch for is how much work it takes for the child to breathe. If kids are using all their muscles to breathe, they're sucking in their bellies or their nostrils are flaring, those are signs that they are working hard to breathe.

Parents should call 911 if they see a bluish tint in their face, or if they're working hard to breathe or if they're not able to stay awake. And even if it's just mild, and parents may still want them checked, they can call their pediatrician or primary care provider. Urgent care or the emergency departments are available for more urgent needs.

Why are younger children at higher risk? Younger children have smaller airways and nasal passages. When a lot of secretions and snot is being made, it clogs up the places that they need to breathe. Kids can develop bronchiolitis, an inflammation in their lungs and that can make it harder for them to breathe. Both increase in secretions and inflammation of the lungs combined can make it very hard for babies and younger kids to breathe.

Will the kids who are hospitalized face any long-term health issues? RSV can inflame the lungs, so they can have some wheezing or some coughing the next time they get sick. We do see that sometimes in younger babies. Usually that goes away over time. It’s not usually permanent damage to their lungs.

What are providers seeing at Kentucky Children's Hospital right now? Capacity has been a major challenge for us. We expanded our beds multiple times and increased our capacity in our emergency rooms. Putting beds in hallway is not optimal, but it's a place that we can give care to kids that need it. And we're continuing to expand. This a challenge that children’s hospitals all over the country are facing, not just in Kentucky. We are working with our hospital leaders to make sure we have the beds and the staffing.

Week over week, the number of RSV cases has been significantly increasing. We have not yet reached our peak surge here in Kentucky. We see 20 to 30 RSV patients admitted to our hospital every day — that's a significant number compared to years past. We're trying to shift all our resources to take care of the kids in Kentucky.

What can we do to mitigate the spread? Because this is a cold virus, a lot of the same preventative measures are the same for any other virus, such as washing hands. That can be hard for kids sometimes because they are always touching things, but make sure they are washing their hands well can help prevent spread. For younger babies, keep them away from people that are sick, even loved ones or family members. Adults can get RSV and it's just like a cold for us. You might not know that you're positive for RSV because it feels like a cold, but if you're kissing, hugging or even just close to a small child, you can easily spread the virus. This is especially important with the holiday season approaching.

Is there any other information that parents, caregivers and the community should know? RSV is not a new virus. It’s a known virus that’s coming at an unusual time. Parents need to protect their kids, but they still need to go to school and do their activities. But they need to double down on making sure everyone in the family is washing their hands, covering their sneezes and staying away from people who are sick.

We’re worried about a big surge in flu cases. Please make sure everyone in the family gets a flu shot, as well as their Covid vaccine. We're still unsure what's going to happen this winter. At KCH, we are really looking at our capacity, and we’re worried that there could be three big viruses all at once (RSV, influenza, Covid). What could that do for our capacity? We're making plans, but the community can really help us by trying to decrease the spread and by getting vaccinated, washing their hands, social distancing when possible and staying home and away from others when they’re sick.

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For the first time, hospitals are dealing with three virus outbreaks: Covid-19, the flu and RSV, which can be rough on young children

Louisville-area hospitals "are dealing with a trio of viruses this fall," reports Dakota Sherek of WDRB. "While fall typically marks the start of flu season, health officials are also dealing with Covid-19 and Respiratory syncytial virus, which can put young children into intensive care.

"Norton Children's Hospital reported more than 200 RSV cases in early October, and two weeks later another 312 RSV cases were reported across the entire system," Sherek reports. Baptist Health Floyd, in New Albany, Ind., reported an uptick of flu and RSV cases.  

"Most people recover from RSV in a week or so, but the respiratory virus can be serious for infants and older adults, according to the Centers for Disease Control and Prevention," Sherek notes. "RSV is the most common cause of bronchiolitis and pneumonia in children less than a year old."

"Seeing some RSV in the fall is not totally unusual," said Dr. Emily Volk of Baptist Health. "The fact that we've got kids back at school at a rate we haven't seen since 2019, before the pandemic, may be playing into this increase in RSV."

Charlotte Ipsen of Norton Healthcare told Sherek that health-care workers haven't dealt with a "true combination" of Covid-19, the flu and RSV, so "We're seeing an already busy hospital even busier."

"The more people who receive vaccinations, the less of a burden hospitals have to bear," Sherek notes. "Covid-19 vaccination protects adults against severe illness from the virus, including hospitalizations and death. The CDC reported rates were 12 times higher among adults who were unvaccinated compared to adults who received a booster or additional doses.

"The more people who get the flu vaccine, the Covid-19 bivalent booster, the fewer patients will need to come into the hospital for care," Volk said. She encourages people who aren't fully immunized to get vaccinated for protection against a variety of viruses.

"We are seeing signs of polio back in the United States," Volk said. "These diseases that we thought were gone forever, it turns out they're not. These immunizations we took for granted, are still very effective and keep you from dying from these diseases."

Social distancing and masking are also important to help curb the spread of viruses, and when someone doesn't feel well, they should stay home, health officials told Sherek.

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After more than two months of pretty steady decline, new Covid-19 cases in Kentucky increased more than 50% last week

By Melissa Patrick
Kentucky Health News

After declining for nine of the last 10 weeks, new coronavirus cases in Kentucky increased by more than half last week.

The state Department for Public Health's weekly report for the latest Monday-to-Sunday reporting period said there were 5,044 new cases last week, or 720 per day. That was nearly 56% higher than the previous week, when the state reported 462 per day. 

New cases in Kentuckians 18 and younger made up only 13% of the total, half of what was reported the prior week. 

The share of Kentuckians testing positive for the coronavirus in the last seven days was 7.64%, down just a bit from the 8.5% reported the week before. This figure does not include at-home tests. 

Kentucky hospitals reported 262 patients with Covid-19 Monday, down nine from the week before; 41 of them were in intensive care, up 13; and 16 were in need of mechanical ventilation, up one. 

The state's new-case rate was 9.7 per 100,000 residents, down slightly from 10.02 a week earlier. The top 10 counties were Leslie, 23.1 per 100,000; Russell, 23.1; Letcher, 22.5; Knott, 22.2; Washington, 17.7; Nelson, 17.3; Cumberland, 17.3; Floyd, 17.3; Perry, 17.2; and Trigg, 16.6.

The New York Times ranks Kentucky's infection rate ninth among the states, with a 39% decrease in cases in the last two weeks. Excluding Puerto Rico's county equivalents, The Times places Letcher, Floyd, Boyd and McCreary counties in the top 10 new-case rates in the nation in the last seven days. (The Times's figures differ from state figures because of differences in data gathering and processing.)

The state attributed 70 more deaths to Covid-19 last week, increasing the pandemic death toll to 17,261.    

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New group says its online survey finds 2/3 of Kentucky adults favor a national health plan, citing costs as their main reason

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Enrollment for subsidized health insurance begins Nov. 1 on Kynect; 'family glitch' fix makes plans available to many more

Kynect illustration

By Melissa Patrick
Kentucky Health News

Open enrollment for federally subsidized health insurance plans starts Nov. 1 and runs through Jan. 15, for coverage that begins Jan. 1. 

Kentuckians can sign up for a qualified health plan on the state-based marketplace, Kynect, at Kynect.ky.gov. On the site, Kentuckians can compare options, apply for coverage and complete all enrollment on one platform. 

"Kynectors," who help Kentuckians sign up for coverage on Kynect, are available at no charge in every county to answer questions and help people sign up for coverage.

Federal subsidies for the plans were expanded during the pandemic, and some of them have been  extended through 2025, including the removal of the "subsidy cliff," allowing people with incomes above 400% of the poverty line to qualify for a subsidy if the full price of the benchmark plan is more than 8.5% of their income.

A Centers for Medicare and Medicaid Services fact sheet says the extension of benefits will continue to be money-savers for people who purchase marketplace plans, noting that "Consumers in these plans saved an average of $800 on their premiums in 2021 as a result of the American Rescue Plan," the first big spending bill passed by Democrats in Congress. 

The Biden administration has also removed what is called the "family glitch," which prevented some families from buying subsidized plans because their employer-based insurance was deemed affordable even though the affordability was based only on the cost of employee' coverage, not the extra premium required to cover dependents.

"This left millions of people, mostly women and children, stuck between being unable to afford unsubsidized coverage from a family member's existing policy while also being deemed ineligible to receive more affordable coverage through the marketplace," Kentucky Voices for Health said in an e-mail.

The Internal Revenue Service now looks at the affordability of an employer's plan by considering premium costs for the entire family. 

The Kaiser Family Foundation estimates that 5.1 million Americans have fallen into the family glitch. KVH estimates the change could affect as many as 72,000 Kentuckians.

Statewide, Kaiser reports that 73,935 people enrolled in individual or family plans during the open enrollment period for 2022 coverage. That was a little lower than 2021, when nearly 78,000 people enrolled.

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Most of Kentucky has a low risk of Covid-19 infection, but the number of counties at high and medium risk increased last week

Centers for Disease Control and Prevention map shows Covid-19 risk.

By Melissa Patrick
Kentucky Health News

The risk of Covid-19 transmission increased just a bit in Kentucky last week, with the latest federal risk map showing 30 counties at either high or medium risk, up from 17 on the prior week's map. 

The Centers for Disease Control and Prevention map, which looks at both cases and hospital data to determine risk, shows four Kentucky counties at high risk, shown in orange; 26 at medium risk, shown in yellow; and 94 counties at low risk, shown in green. 

Counties at high risk are Magoffin, Johnson, Floyd and Letcher. Last week, only Letcher was.

In high-risk counties, the CDC continues to recommend that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Centers for Disease Control and Prevention map

The CDC also has a transmission-level map that shows the level of virus spread in each county, at one of four levels. The map shows Fulton, Hickman and Webster counties with low levels of transmission and 40 counties with moderate levels. The rest have either substantial or high levels of transmission. This data is largely used by researchers and health-care facilities. 

State health officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures.

The New York Times ranks Kentucky's infection rate ninth among states, with a 10% drop in cases in the last two weeks. 

At his weekly news conference, Gov. Andy Beshear celebrated the prior week's risk map that showed only one high-risk county and noted that this is the seventh straight week of decreasing cases. He also  encouraged Kentuckians to get boosted before the holidays, noting that the new updated booster shot will protect you against the Omicron variants that are circulating now as well as the new strains that are beginning to take hold in the U.S.  

"People get out there and get your booster, especially before Thanksgiving," he said. "You're gonna get together [and] we never want the holidays to make people sick."

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Beshear announces initiative that will expand Medicaid dental, vision and hearing benefits for more than 900,000 Ky. adults

Dept. for Medicaid Services graphic

By Melissa Patrick

Kentucky Health News

Pitching it as a way to expand the state's workforce, Gov. Andy Beshear announced Thursday the expansion of dental, vision and hearing benefits for 900,000 Kentucky adults on Medicaid.  

"One of the major obstacles in getting some people into the workforce is they're simply not healthy enough to do it. Challenges in their health are preventing them from either looking for or securing a job," Beshear said at his weekly news conference.

"These are really basic things, folks. If  you can't see, it's really hard to work. If you can't hear the instructions that you're getting, it's really hard to work. If you have massive dental problems that are creating major pain or other complications, it's really hard to work.. . . Today, we're announcing that for many Kentuckians, we're removing the roadblocks that they face in accessing dental, vision and hearing care." 

Beshear said the vast majority of the program will be paid by the federal government and the rest of it will be absorbed into the existing Medicaid budget. "It will require no changes to our budget in this next session," he said. "In other words, it is easily affordable, which means we absolutely should do it."  

Susan Dunlap, spokeswoman for the  Cabinet for Health and Family Services, told the Louisville Courier Journal that federal funds would cover 90% of the estimated $36 million annual cost for the expansion, with the state covering the rest. She added that the state's move to one pharmacy benefit manager last year "has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward."

Medicaid is a state-federal program that provides health insurance for low-income adults and pregnant women, the disabled, and families with incomes at or below 138% of the federal poverty level, which amounts to about $18,700 per year for an individual or $38,200 for a family of four. Youth 21 and under who are enrolled in Medicaid already qualify for dental, vision and hearing services.

Kentucky adults on Medicaid already have access to some dental and vision benefits; the hearing benefits are very limited. Starting on Jan. 1, those benefits will be greatly expanded.

For example, the only dental services Medicaid now covers for adults are an annual cleaning a year and extractions based on certain medical conditions. Dunlap said fillings are not covered for adults, but the expansion will add coverage for fillings, dentures, implants,  root canals, extractions, restorations, periodontics and an additional cleaning each year. 

Dunlap said the new hearing benefits will cover screening tests and hearing aids for adults. Now an adult can be evaluated only if they had a referral from their primary doctor. 

The vision changes will cover eyeglasses and contacts for adults. Now, vision exams are covered by Medicaid, but glasses and contact lenses are not. 

Managed-care organizations, which provide care for Kentuckians on Medicaid, were already offering some of these services as extra benefits to incentivize beneficiaries to choose their company. 

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded Beshear's decision to expand benefits, noting the value of employment as one of the most important "social drivers of health." 

“All of the data shows that when you work, you've got a much better chance of having good health," he said. "So, it's a circular thing. You have to have good health to be able to work and you have to be able to work to have good health.”

One of the challenges that people on Medicaid already have when it comes to getting dental care is that there aren't enough dentists who will accept Medicaid insurance, mainly because the rates are so low. 

Asked about this, Beshear said, "We are going to have to make sure that there is access all across Kentucky," he said. "When you think of health care, it has to be affordable. . . . So it's going to be hard work. We're going to see what those barriers are, but it's about commitment and being intentional to make sure we get health care to those folks. " 

Dunlap said Kentucky is submitting the state Medicaid plan amendment to make these changes to the Centers for Medicare and Medicaid Services and that they do not anticipate any issues with approval. 

Open enrollment for Medicaid members runs through Dec. 1 for coverage beginning Jan. 1. Medicaid open enrollment gives Medicaid members a chance to change the insurance company that manages their care.  Medicaid members who chose to not participate in open enrolment will keep the same managed care organization, or MCO, that they are currently enrolled in.

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Half of Kentuckians on Medicare now have Advantage plans, but such plans have smaller networks and marketing issues

Image from Investopedia.com

By Melissa Patrick
Kentucky Health News

With open enrollment for Medicare plans up and running, it's important that seniors pay close attention to what each type of Medicare plan offers and to make sure to choose a plan that meets their needs.  \

Increasingly, seniors are choosing privatized Medicare Advantage plans over traditional Medicare, but are leaving those plans when they get older and sicker because they don't offer what they need.

The Kaiser Family Foundation reports that nearly half, or 48%, of the eligible Medicare population, had enrolled in a Medicare Advantage plan in 2022. In Kentucky, where health-insurance giant Humana is based, share of Medicare beneficiaries in such plans is already 50%. The Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61% by 2032.

A survey by The Commonwealth Fund, a foundation aimed at improving health care, found that more benefits and a limit on out-of-pocket costs are the main reasons seniors gave for selecting Medicare Advantage, while greater selection of providers is cited by those opting for traditional Medicare.

The report on the survey explains the trade-offs between Advantage and traditional plans: "Advantage plans typically provide some coverage for benefits not included in traditional Medicare, such as eyeglasses. Plans also have a cap on out-of-pocket expenses for services covered by traditional Medicare, while traditional Medicare does not have a similar limit.

"On the other hand, traditional Medicare allows beneficiaries to go to any doctor, hospital, or other health care provider that accepts Medicare, without the need for prior approval; Medicare Advantage enrollees typically need a referral from their primary care physician as well as plan approval if they want services from specialists, such as oncologists, covered by the plan." 

The survey found that while about 40% of the Medicare beneficiaries surveyed said they did not receive any help choosing their plan, about one in three of them, regardless of coverage, used an insurance broker or agent to choose a plan. 

In addition, it found that less than 10% of those surveyed, regardless of coverage, said they used the free federal Medicare.gov website and 24/7 hotline or the State Health Insurance Assistance Program, which is a free service that provides information, counseling and assistance to seniors and disabled individuals, their families and caregivers about their health insurance coverage, benefits and consumer rights. 

That matters, because it's important for beneficiaries to know that their broker or agent is getting paid a commission by the insurers, which can influence the information they provide whereas government funded programs are designed to provide unbiased, one-on-one help, the authors write. 

Ongoing issues with Medicare Advantage

Medicare Advantage is supposed to save money by paying health-insurance companies set fees for managing the care of each enrollee. Last year, Bob Herman of Axios reported that Advantage plans are falling short of their promise, noting that federal spending on them has outpaced enrollment growth in every year since 2015.

Herman notes that private-plan contracting that results in a narrower network of doctors and hospitals has not yielded savings to Medicare. He writes that many seniors don't stick with Advantage plans, often ditching them in the last years of life because they get sicker and need more care, and their Advantage plans limit access to the doctors, hospitals, nursing homes and hospice care that they want. 

More recently, Victoria Knight of Axios reported on the increasing complaints about the aggressive marketing tactics being used by Medicare Advantage plans that have led to seniors being signed up for plans without their consent or enrolling in plans that don't offer the benefits they were promised. 

The Centers for Medicare and Medicaid Services, acknowledging the problem, now requires marketers to include disclaimers in advertisements about plans, to discourage deceptive sales practices, Knight reports. She says CMS received almost 40,000 complaints from beneficiaries about the marketing of Medicare Advantage plans last year, up from about 5,700 in 2017. 

In the U.S. House, more than 30 Democrats, led by Ways and Means Health Subcommittee Chair Lloyd Doggett (D-Texas), have recommended changes to Medicare Advantage that would rein in aggressive and misleading marketing, protect taxpayer dollars, prevent delays and medically unnecessary restrictions to accessing care, and end a program that puts beneficiaries into arrangements that are similar to Medicare Advantage without their knowledge or consent.  

Open enrollment for Medicare runs through Dec. 7, for coverage starting Jan. 1. Open enrollment is a time that allows seniors to join, switch or drop a plan. 

If you are already enrolled in a Medicare Advantage Plan, you can switch to a different Advantage plan or switch to traditional Medicare one time between Jan. 1 and March 31, for coverage that starts the first day of the month after you ask to join the plan. Click here to learn more about how to join, switch or drop a Medicare plan on Medicare.gov. 

One question to be sure to ask if you choose to switch back to a traditional Medicare plan is whether you will have access to Medigap coverage without an insurer scrutinizing your health status, recognizing that if you have developed a pre-existing condition, you may be ineligible for a Medigap policy. 

A Medigap plan is also called a Medicare supplement. It  is sold by private companies to help pay some of the health care costs that traditional Medicare does not cover.

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Denise Hall awarded Gil Friedell Health Policy Award for her substance-use prevention efforts with youth in Trimble County

Left to right: Foundation for a Healthy Kentucky Board Chair Dr. Clifford Maesaka, Denise Hall, Foundation President and CEO Ben Chandler, and Council President Tim Marcum.

Denise Hall of Trimble County is this year's winner of the Foundation for a Healthy Kentucky's Gil Friedell Health Policy Award for her  substance-use prevention efforts among youth. 

“Drug addiction is something far too many Kentuckians have seen first-hand, and that’s why Denise Hall’s work is so critical,” said Ben Chandler, president and CEO of the foundation. “Her efforts to prevent future addictions and support the overall wellbeing of the youth of her community makes her the perfect person to receive the Friedell Award. At a time when so many young people are struggling with their mental health, Trimble County students can take comfort in knowing what a strong advocate they have on their side.”

Hall began working in the substance-use prevention field in 1998 at Seven Counties Services. In 2003, she became coordinator for the Trimble County Family Resource and Youth Services Center, an organization that connects students and their families to needed services, like utility assistance or clothes and food, as a way to remove nonacademic barriers to learning. 

While with the FRYSC, Hall wrote two Drug Free Communities grants and directed them. In 2017, she gave up her coordinator position to focus on the grant program, which is in its 10th and final year. 

Hall retired Oct. 1, with plans to assist local nonprofits and schools with grant writing and continue attending meetings of the Trimble CARES Coalition, of which she was managing director. CARES stands for Community Assessing Resources and Education on Substance misuse. 

Hall’s work also includes implementing a Drug Education Series and a Sources of Strength group at Trimble County Junior/Senior High School. She made tools such as drug-testing kits and medication-deactivation kits available to parents and she provided one-on-one education for students who violated school drug and alcohol policies. She was also crucial in getting vape detectors installed at the high school. She has written grants for a small kitchen that allows for life-skills lessons in a special-needs classroom and for a washer and dryer at TCJSHS, and was instrumental in finding money to build a new wheelchair ramp after the old one broke. 

“I am so honored to be chosen for this award,” Hall said. “So many wonderful people worked on these projects with me, and we so appreciate the amazing students of this community.”

The Memorial Health Policy Award is named for Gil Friedell, first director of the Markey Cancer Center at the University of Kentucky and cofounder of the Kentucky Cancer Registry. He helped launch a nonprofit advocacy education organization in 2005 that later became the Friedell Committee for Health System Transformation. The Foundation created the award when it united with the Friedell Committee in 2018.

The foundation makes a $5,000 grant to a Kentucky nonprofit working to improve health policy in the commonwealth in honor of the Friedell Award winner. Hall selected Trimble CARES Coalition, which works against the harmful effect of substance abuse and strives to ensure that all youth have support available to make positive, healthy choices.

Hall was selected from the foundation's 2022 Healthy Kentucky Champions, Kentuckians honored for making a difference in the health of their communities or the state. Click here to nominate someone for the 2023 class of Healthy Kentucky Champions. 

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Analysis: First TV commercial from anti-abortion group has misleading and inaccurate wording, Herald-Leader writer says

Image from TV ad, provided by Yes for Life

The first television spot from the main group supporting the anti-abortion proposal on Kentucky's Nov. 8 ballot "relies on conservative buzzwords and phrases that are aimed at grabbing viewer attention but are ultimately misleading and inaccurate," writes Alex Acquisto of the Lexington Herald-Leader.

The 30-second ad by Yes for Life begins, “Radical, out-of-state activists want to spend your tax dollars on late-term abortions, even up to the moment of birth.”

Taxpayer funding of abortion "is already illegal under Kentucky law and regulated by federal law," Acquisto notes. "The Hyde Amendment bars the use of federal aid programs, like Medicaid, to pay for abortion."

As for “late-term abortions,” the term "typically refers to an abortion at roughly 21 weeks of pregnancy," Acquisto writes. "Rarely, and typically only for medically-necessary reasons, are abortions provided later than that. Late-term abortions 'even up to the moment of birth' is largely a misnomer. In Kentucky last year, 26 of the 4,441 total abortions provided — or about 0.6% — were at 21 weeks of pregnancy, according to the state Office of Vital Statistics. There were no other abortions reported at a later stage of pregnancy in 2021. Of the 18,614 total abortions reported in Kentucky since 2017, 13 were at or beyond 22 weeks of pregnancy."

The spot tells viewers that a “yes” vote for Constitutional Amendment No. 2 is a “reasonable, common sense vote.”

The amendment would place in the state constitution a statement saying that the document shall not be construed to "secure or protect a right to abortion or require the funding of abortion." Its intent is to leave Kentucky abortion law up to the state legislature, and keep state courts from finding in the constitution a right to abortion.

Voters' approval of the amendment would render moot a case the state Supreme Court is scheduled to hear Nov.15, a week after the election.

The lawsuit by abortion-rights supporters challenges the "trigger law" that virtually banned abortion in Kentucky when the U.S. Supreme Court overturned its 1973 Roe v. Wade decision, and another law banning abortion after the sixth week of pregnancy. The immediate question before the court is whether to reinstate an injunction blocking those laws passed by the legislature.

The injunction has been blocked by a Court of Appeals judge. It was issued by Jefferson Circuit Judge Mitch Perry on grounds that the lawsuit was likely to succeed, based on sections of the state constitution that guarantee religious freedom and say Kentuckians have “the right of seeking and pursuing their safety and happiness” and “Absolute and arbitrary power over the lives, liberty and property of freemen exists nowhere in a republic, not even in the largest majority.” Kentucky courts have found in those words a limited right to privacy, which was the basis for Roe v. Wade and similar decisions in other states.

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New cases of Covid-19 in Kentucky dropped 4% last week, but the state still has the highest infection rate in the nation

New York Times map, adapted by Kentucky Health News (Click to enlarge; interactive version is here.)

By Melissa Patrick

Kentucky Health News

New coronavirus cases in Kentucky dropped a bit last week, even as the share of Kentuckians who were tested for the virus increased and the state's rate of new cases remained first in the nation. 

The state Department for Public Health's report for the latest Monday-to-Sunday period said there were 3,240 new cases last week, or 462 per day. That was 4% fewer than the previous week, when the state reported 484 per day. 

New cases in Kentuckians 18 and younger were lower than in the last month. The latest report showed 26%, or 848, of the cases in this age group. Last time, they were 39% of the total. 

The only school-age group that has increased its vaccination rate since Sept. 26, the last time Kentucky Health News reported rates, are 16- and 17-year-olds, who rose to 47% from 43%, state data show. Whole-number percentages for younger groups remained the same: 43% of those 12 to 15, 20% of those 5 to 11, and 2% of those 6 months to 4 years old were fully vaccinated.  

The share of Kentuckians testing positive for the coronavirus was 8.5%, up from 7.91% in the prior week's report and 7.7% the week before that. This figure does not include at-home tests. The rate has gone up the last two weeks as fewer tests have been reported (30,963 last week, 37,326 two weeks ago).

Kentucky hospitals reported 253 patients with Covid-19 Monday, down 34 from the week before; 28 of them in intensive care, down 18; and 15 of them on mechanical ventilation, up two. 

The state's new-case rate was 10.02 cases per 100,000 residents, down slightly from 10.25 a week earlier. The top 10 counties on the state report were Green, 37.9; Letcher, 32.5; Russell, 31.1; Leslie, 20.2; Powell, 19.7; Henry, 19.5; Nelson, 19.5; Perry, 19.4; Gallatin, 19.3; and Simpson, 16.9 per 100,000.

The New York Times again ranks Kentucky's infection rate first in the nation, even though it fell 6% in the last 14 days. The Times places McCreary, Perry, Floyd, Letcher and Knott counties among the nation's top 10 new-case rates in the nation in the last seven days. (The Times's figures differ from state figures because of differences in data gathering and processing.)

The state attributed 80 more deaths to Covid-19 last week, increasing the pandemic's death toll to 17,191.

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Is Covid-19 about to spike again? Six tips to help you stay safe

By Céline Gounder
Kaiser Health News

Last year, the emergence of the highly transmissible Omicron variant of the Covid-19 virus caught many people by surprise and led to a surge in cases that overwhelmed hospitals and drove up fatalities. Now we’re learning that omicron is mutating to better evade the immune system.

Omicron-specific vaccines were authorized by the FDA in August and are recommended by U.S. health officials for anyone 5 or older. Yet only half of American adults have heard much about these booster shots, according to a recent Kaiser Family Foundation poll, and only a third say they’ve gotten one or plan to get one as soon as possible. In 2020 and 2021, Covid cases spiked in the U.S. between November and February.

Although we don’t know for sure that we’ll see another surge this winter, here’s what you should know about COVID and the updated boosters to prepare.

1. Do I need a Covid-19 booster shot this fall? If you’ve completed a primary vaccination series and are 50 or older, or if your immune system is compromised, get a Covid booster shot as soon as possible. Forty percent of deaths are occurring among people 85 and older and almost 90% among people 65 and over. Although people of all ages are being hospitalized from Covid, those hospitalizations are also skewing older.

Unvaccinated people, while in the minority in the U.S., are still at the highest risk of dying from Covid-19. It’s not too late to get vaccinated ahead of this winter season. The United Kingdom, whose Covid waves have presaged those in the United States by about a month, is beginning to see another increase in cases.

If you’ve already received three or more Covid-19 shots, you are 12 to 49 years old, and you’re not immunocompromised, your risk of hospitalization and death from the disease is significantly reduced and additional boosters are not likely to add much protection.

However, getting a booster shot provides a “honeymoon” period for a couple of months after vaccination, during which you’re less likely to get infected and thus less likely to transmit the virus to others. If you’ll be seeing older, immunocompromised, or otherwise vulnerable family and friends over the winter holidays, you might want to get a booster two to four weeks in advance to better shield them against Covid-19.

You may have other reasons for wanting to avoid infection, like not wanting to have to stay home from work because you or your child is sick with Covid-19. Even if you aren’t hospitalized from Covid, it can be costly to lose wages or arrange for backup child care.

One major caveat to these recommendations: You should wait four to six months after your last Covid-19 infection or vaccination before getting another shot. A dose administered too soon will be less effective because antibodies from the previous infection or vaccination will still be circulating in your blood and will prevent your immune cells from seeing and responding to vaccination.

2. Do children need to be vaccinated even if they’ve had Covid-19? Although children are at lower risk for severe Covid than adults are, the stakes for kids are higher than many diseases already recognized as dangerous. Their risk shouldn’t be measured against the risk that Covid poses to other age groups but against the risk they face from other preventable diseases.

In the first two years of the pandemic, Covidwas the fourth or fifth leading cause of death in every five-year age bracket from birth to 19, killing almost 1,500 children and teenagers. Other vaccine-preventable diseases like chickenpox, rubella, and rotavirus killed an average of 20 to 50 children and teens a year before vaccines became available. By that measure, vaccinating kids against Covid is a slam-dunk.

Children who have had Covid-19 also benefit from vaccination. The vaccine reduces their risk of hospitalization and missing days of school, when parents might need to stay home with them.

But it’s precisely because the stakes are higher for kids that many parents are anxious about getting their children vaccinated. As recently as July, just after the FDA authorized Covid vaccines for children as young as 6 months, a KFF poll found that over half of parents of children under age 5 said they thought vaccines posed a greater risk to the health of their child than getting the disease. And in the most recent poll, half said they had no plans to get their children vaccinated. Covid vaccination rates range from 61% among children ages 12 to 17 to 2% among kids younger than 2.

Similar to influenza, Covid-19 is most deadly for the very youngest and oldest. At especially high risk are infants. They’re unlikely to have immunity from infection, and a small share have been vaccinated. Unless their mothers were vaccinated during pregnancy or got Covid during pregnancy — the latter of which poses a high risk of death for the mother and of preterm birth for the baby — infants are probably not getting protective antibodies against Covid through breast milk. And because infants have small airways and weaker coughs, they’re more likely to have trouble breathing with any respiratory infection, even one less deadly than Covid.

3. Will I need a Covid-19 shot every year? It depends on the targets set by public health officials whether Covid-19 becomes a seasonal virus like the flu, and how much the virus continues to mutate and evade humanity’s immune defenses.

If the goal of vaccination is to prevent severe disease, hospitalization, and death, then many people will be well protected after their primary vaccination series and may not need additional shots. Public health officials might strongly recommend boosters for older and immunocompromised people while leaving the choice of whether to get boosted to those with lower risk. If the goal of vaccination is to prevent infection and transmission, then repeat boosters will be needed after completing the primary vaccination series and as often as a couple of times a year.

Influenza is a seasonal virus causing infections and disease generally in the winter, but scientists don’t know whether Covid-19 will settle into a similar, predictable pattern. In the first three years of the pandemic, the United States has experienced waves of infection in summer. But if the Covid virus were to become a wintertime virus, public health officials might recommend yearly boosters. The Centers for Disease Control and Prevention recommends that people 6 months and older get a flu shot every year with very rare exceptions. However, as with the flu, public health officials might still place a special emphasis on vaccinating high-risk people against Covid.

And the more the virus mutates, the more often public health officials may recommend boosting to overcome a new variant’s immune evasion. Unfortunately, this year’s updated omicron booster doesn’t appear to provide significantly better protection than the original boosters. Scientists are working on variant-proof vaccines that could retain their potency in the face of new variants.

4. Are more Covid-19 variants on the way? The Omicron variant has burst into an alphabet soup of subvariants. The BA.5 variant that surfaced earlier this year remains the dominant variant in the U.S., but the BA.4.6 omicron subvariant may be poised to become dominant in the United States. It now accounts for 14% of cases and is rising. The BA.4.6 omicron subvariant is better than BA.5 at dodging people’s immune defenses from both prior infection and vaccination.

In other parts of the world, BA.4.6 has been overtaken by BA.2.75 and BF.7 (a descendant of BA.5), which respectively account for fewer than 2% and 5% of Covid cases in the U.S. The BA.2.75.2 omicron subvariant drove a wave of infections in South Asia in July and August. Although the U.S. hasn’t yet seen much in the way of another variant descended from BA.5 — BQ.1.1 — it is rising quickly in other countries like the U.K., Belgium, and Denmark. The BA.2.75.2 and BQ.1.1 variants may be the most immune-evasive omicron subvariants to date.

BA.4.6, BA.2.75.2, and BQ.1.1 all evade Evusheld, the monoclonal antibody used to prevent Covid in immunocompromised people who don’t respond as well to vaccination. Although another medication, bebtelovimab, remains active in treating Covid from BA.4.6 and BA.2.75.2, it’s ineffective against BQ.1.1. Many scientists are worried that Evusheld will become useless by November or December. This is concerning because the pipeline for new antiviral pills and monoclonal antibodies to treat Covid is running dry without a guaranteed purchaser to ensure a market. In the past, the federal government guaranteed it would buy vaccines in bulk, but funding for that program has not been extended by Congress.

Other omicron subvariants on the horizon include BJ.1, BA.2.3.20, BN.1, and XBB, all descendants of BA.2. It’s hard to predict whether an omicron subvariant or yet another variant will come to dominate this winter and whether hospitalizations and deaths will again surge in the U.S. Vaccination rates and experience with prior infections vary around the world and even within the United States, which means that the different versions of omicron are duking it out on different playing fields.

While this might all sound grim, it’s important to remember that COVID booster shots can help overcome immune evasion by the predominant omicron subvariants.

5. What about long Covid? Getting vaccinated does reduce the risk of getting long Covid, but it’s unclear by how much. Researchers don’t know if the only way to prevent long Covid is to prevent infection.

Although vaccines may curb the risk of infection, few vaccines prevent all or almost all infections. Additional measures — such as improving indoor air quality and donning masks — would be needed to reduce the risk of infection. It’s also not yet known whether prompt treatment with currently available monoclonal antibodies and antiviral drugs like Paxlovid reduces the risk of developing long Covid.

6. Do I need a flu shot, too? The CDC recommends that anyone 6 months of age or older get an annual flu shot. The ideal timing is late October or early November, before the winter holidays and before influenza typically starts spreading in the U.S. Like Covid shots, flu shots provide only a couple of months of immunity against infection and transmission, but an early flu shot is better than no flu shot. Influenza is already circulating in some parts of the United States.

It’s especially important for people 65 or older, pregnant women, people with chronic medical conditions, and children under 5 to get their yearly flu shots because they’re at highest risk of hospitalization and death. Although younger people might be at lower risk for severe flu, they can act as vectors for transmission of influenza to higher-risk people in the community.

High-dose flu vaccines, also called “adjuvanted” flu vaccines, are recommended for people 65 and older. Adjuvants strengthen the immune response to a vaccine.

It is safe to get vaccinated for Covid and the flu at the same time, but you might experience more side effects like fevers, headache, or body aches.

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FDA chief, at UK, says 'It's fair to be critical' of failure to control e-cigarettes; voices concern about life expectancy, misinformation

By Melissa Patrick
Kentucky Health News

U.S. Food and Drug Administration Commissioner Dr. Robert Califf said Friday at the University of Kentucky, "It's fair to be critical of the FDA" regarding the agency's struggle to regulate electronic cigarettes.

Asked in a news-media interview what the FDA is doing to crack down on e-cigarette companies that defy FDA rules and continue to sell their products, with reports that the FDA is not enforcing the law to shut them down, Califf replied that this is a "tough issue." 

Robert Califf, M.D.

Califf said that while federal law requires the companies to submit an application to the FDA to determine if they can stay on the market, it turns out that there are 6.7 million vape products, which "no one expected." He said there were already a million synthetic nicotine products by the time Congress passed a law to cover them.

"It's been a lot more labor-intensive than was expected," he said. "We're doing a complete evaluation now that will be out in December and enforcement is a big part of that. And I would just say, it's fair to be critical of the FDA in this regard.

"But in order for FDA to have enforcement, like taking things off the shelves, that involves other branches of government also. And so we've got to figure out how to adapt to a much more creative industry than we expected in terms of all the products that are developing and the way they're dealing with it." 

As a guest speaker at UK Healthcare's 60th Anniversary Symposium, Califf touched on a number of health-related topics very relevant to Kentucky, including tobacco use, decreasing life expectancies and the role of health-related misinformation.

He said Kentucky still has work to do on tobacco use, since it still has one of the top rates in the country (21.4% of adults) and is likely to lose about 8,000 people this year to tobacco-related illnesses.

"So we've got to work together to help people stop using tobacco or reduce their use of tobacco . . . and underneath that, we've got vaping, which is rising while the use of tobacco is declining," Califf said in the interview. "Those things are right in the core mission of the FDA." 

The FDA is working on a proposal to remove menthol from tobacco products to discourage smoking. The move has been long in coming because menthol cigarettes are the choice of most Black smokers. 

"Get rid of that and you're pretty much left with tobacco-flavored tobacco," he said. "That's going to, I think, be a disincentive for people to continue to use it. . . . Law prohibits us from eliminating tobacco products, you can't take them completely off the market."  

Life expectancy: Califf voiced grave concern that life expectancy, the most basic measure of population health, has decreased in the U.S. during the pandemic and is five years shorter than the average of other high-income countries. He pointed out that life expectancy is lower in the Appalachian region and the Southeast. 

"We've got very significant work to do if we're going to turn this around," he said, adding later, "It's something that I believe is an emergency that we need to take seriously, and it's something that is not sustainable."  

One of the ways to improve life expectancy, he said, is to improve health outcomes, which include things that we already know how to treat like obesity, low physical activity, cigarette smoking, high blood pressure and diabetes -- all conditions that plague Kentuckians. He also noted the widening disparities in health outcomes in rural people, compared to urban ones. 

"These are things that are not foreign objects to us, we understand them reasonably well," he said. "We're just not doing a good job of executing on the things that we already know."

He later told reporters that experts say it will be important to fix the underlying social determinants that impact health if we are ever going to move the needle on health outcomes, including things like fundamental economic and income distribution and the education system. 

"The good news for our health is, poor people can have really good health because you are talking about blood pressure, cholesterol level, use of tobacco, simple screening things that aren't very expensive. The most important drugs now are generic . . . so this is why I keep gravitating back to having a primary-care system that works." 

The role of the FDA in all of this would be in the regulation of food and nutrition and tobacco and digital products that would enhance better health outcomes, he said. 

He touched briefly on the increasing number of deaths caused by substance-use disorders, but did say that there is a great need for a non-addictive treatment for pain, which we don't have yet. 

Misinformation: Califf spent a fair amount of time talking about health misinformation, which he defined as when well-intentioned people get health information wrong and then influence a lot of people by sharing that bad information. He said it is largely driven by the widespread use of social media and the internet.

"I can't find a single expert who can put credibly put forth a strategy that will turn around the fact that we're losing the battle on misinformation right now," he said. 

Califf called on state health institutions and health professionals to actively work to dispel misinformation, most recently as it relates to the Covid-19 vaccinations and boosters. 

"We know that the most effective way to counter misinformation is through human interpersonal interaction with someone that you trust," he said "If we don't build this in as an active part of our medical education, what our doctors and nurses and pharmacists to in day to day work, we're going to lose." 

As for the FDA's role, Califf said one of the agency's missions is to provide people with reliable information about products, and the FDA will continue to put out reliable information. 

"We have a responsibility to try to do something about it, but it's overwhelming," said Califf, who is serving in his role as FDA commissioner for the second time. "The government can't fix this because there's so much mistrust of government that we need the private sector to pitch in. And we need the press to pitch in and be aware of when it's promoting misinformation and things that will affect people's health in a negative way." 

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