Opinion: Without herd immunity, we need masking, ventilation, germicidal lighting, clearer messaging to prevent Covid-19

By Kevin Kavanagh

We all need to recognize the dangers of Covid-19 and the risks it imposes to our long-term health and our country’s workforce. Long Covid occurs in about 30% to 35% of cases. It commonly occurs with even mild disease and with reinfections. The severity is additive, with each exposure, and the symptoms can often persist for over a year (the longest that patients have been followed).

There is no such thing as “herd immunity” and I beg to differ with the CDC regarding “immune debt” causing the current increase in respiratory infections, and their statement regarding respiratory syncytial virus infections: “And so these children, if you will, need to become infected [with RSV] to move forward because it’s a disease very common in children.”

Kevin Kavanagh

“Immune debt” is just another push for “herd immunity,” and to use this to explain the increase in RSV infections is mind-boggling, since we had a significant number of infections last year. At the end of November this year, pediatric hospitals were filled with RSV, but at that time there were corresponding more RSV infections in the previous year. We are on track to have an even larger RSV season, but “immune debt” is an unlikely cause.

Another explanation for rising RSV hospitalizations is “immune theft” due to Covid-19, which as of last March had infected over 75% of children. Mounting research has shown that Covid-19 is associated with immune dysfunction which can persist for at least eight months (the longest time studied).

Poor ventilation

Why not make indoors as safe as outdoors? Unfortunately, increasing ventilation alone is unlikely to stop the spread of Covid-19. But poorly ventilated areas are by far the least safest places. Consumers can use a portable CO2 monitor to at least make sure minimum non-pandemic standards are being met. We do have the technology to greatly improve indoor settings. It is decades old and has an excellent safety record. It is called upper room germicidal UV-C lighting.

We also need to use well-fitted N95 masks whenever possible, especially when encountering others on short exposures during store pickups. The public repulsion to masking is both social and based on fake science. The viral particles which float in the air are droplets, much larger than one micron. But most importantly, an N95 mask is not a strainer. N95 masks work more like flypaper, trapping viruses because they stick to the fibers, and not because they are blocked by them. N95 masks are extremely good at capturing very small particles.

We need proper and clear messaging to retailers regarding standards for indoor safety and N95 masking, but the CDC is airing a commercial which appears to promote mask-less congregation in crowded indoor settings (elevator, public transportation, etc.) for those who have been boosted. This messaging ignores the suboptimal efficacy rates of boosters in preventing symptomatic disease, spread and even Long Covid.

Vaccinations

Vaccinations and boosting do provide another layer of protection, but according to a large National Institutes of Health study, they only provide 34% to 38% protection against Long Covid. They also do not eliminate symptomatic infections and spread. These are all too common. However, vaccines do provide good protection against hospitalization and death. What is needed is a mucosal vaccine which produces large quantities of immunoglobulin antibodies inside the nose, which should stop the spread of disease. There are promising vaccines being studied. The absence of an “Operation Warp Speed” initiative for these mucosal vaccines is one of the greatest failings of our pandemic effort.

Whenever possible, consumers should use online shopping, curbside pickup and as a last resort in-store pickup. Retail establishments need to offer these options, plus make sure their personnel are wearing N95 masks. Rapid testing is also important. We all should be testing immediately before indoor gatherings and family events. A recent study from Yale found this strategy could decrease spread by 40%.

Thus, testing, masking, avoiding indoor crowded settings along with keeping vaccinations and boosters up to date are the best strategies we have to stay safe during times of high viral spread. These strategies will also work with the seasonal flu and will also help to protect against RSV, for which there is no vaccine.

Above all, we need to have clear and comprehensive public-health messaging. We must be willing to make a few compromises in the way we live, for the safety of others and ourselves.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA, which is dedicated to infection control. This was originally published in the Louisville Courier Journal.

Read More

Suit claims Morehead hospital refused to grant all requests from workers for religious exemptions from Covid-19 vaccine mandate

St. Claire Medical Center (Photo from The Daily Yonder)

A woman who says she was fired by St. Claire Medical Center for not getting a Covid-19 vaccine is suing the hospital in federal court, alleging that the Morehead hospital denied the religious exemption she claimed, and those of all other employees who claimed such an exemption.

Teffany Smith of Olive Hill filed the lawsuit in federal court, but cited the state law banning religious discrimination by employers. Smith, who was a lab assistant, says she was fired Sept. 15, 2021, the day that each hospital employee was required to be vaccinated.

The suit says Smith submitted an exemption citing several passages of Scripture and a letter from a pastor, Joyce Stapleton of New Life Victory Church in Olive Hill, who said the vaccine “violates laws put forth within us by a higher power at the time of conception. . . . We believe in healing and that is what our God provides.” The church website lists different pastors.

Smith also "alleges the hospital did not engage in a good-faith dialogue and consideration of proposed accommodations for not receiving the vaccine," Taylor Six of the Lexington Herald-Leader reports. "St. Claire Healthcare officials did not respond to request for comment."

Read More

Ky. coronavirus cases stay on rough plateau; a few more counties at higher risk; former Gov. Brown died of Covid-19 complications

CDC map shows risk of Covid-19 by county.

By Melissa Patrick
Kentucky Health News

The number of new coronavirus cases in Kentucky continues to fluctuate each week, but on a rough plateau. Meanwhile, the latest federal risk map shows most of the state's counties continue to have a low risk of transmission. 

The state Department for Public Health reported 3,866 new cases last week, or 552 per day. That's a 43% drop over the prior week, when the state reported 6,746 new cases, a number that was nearly double the week before that. Of last week's new cases, nearly 13% were in people 18 and younger. 

The share of Kentuckians testing positive for the virus last week was 7.03%, just slightly higher than the week prior, when the rate was 6.73%. The figures do not include at-home tests. 

The weekly new-case incidence rate was 10.61 cases per 100,000 residents, down a bit from 10.87 the week prior. Three counties had an incidence rate more than double the state rate: Robertson, at 54.2 cases per 100,000; Henry, 26.6; and Mercer, 22.8. The other top 10 counties were Johnson, 20.0; Elliott, 19.0; Edmonson, 17.6; Morgan, 17.2; Marshall, 16.5; Jefferson, 16.4; and Gallatin, 16.1.

The New York Times ranks Kentucky's incidence rate fourth among states, with a 17% increase in cases in the last two weeks. 

The number of patients in Kentucky hospitals with Covid-19 increased after dropping for two weeks in a row. Hospitals reported 281 Covid-19 patients Monday morning, an increase of 31 over the prior Monday; 40 were in intensive care, five more than the week prior; and nine were on mechanical ventilation, down five.

One of those who went off mechanical ventilation and died last week, at the age of 88, was former Gov. John Y. Brown Jr. "According to Brown’s children, he died due to a series of health problems that stemmed from Covid-19 complications which began this summer," the Lexington Herald-Leader reported. Lincoln and Pamela Brown said he was in intensive care at the University of Kentucky's Albert B. Chandler Hospital in Lexington for three weeks.

The state attributed 43 more deaths to Covid-19 last week, down from 49 the week prior. Kentucky's pandemic death toll is 17,502. 

The Centers for Disease Control and Prevention risk map ,which was released Monday instead of last Thursday due to the Thanksgiving holiday, shows an increase in counties at medium and high risk in Kentucky. 

The map, which looks at both cases and hospital data to determine transmission risk, shows 15 Kentucky counties  at medium risk of Covid-19, shown in yellow, and three at high risk, shown in orange. Low risk counties are shown in green. Last week, only 10 counties were shown to have a medium risk of transmission. 

The high risk counties are Magoffin, Johnson and Floyd. In such 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.

CDC map shows coronavirus transmission levels.

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. The map shows 33 counties at moderate levels of transmission and 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.

Read More

Study: Suicide rates in U.S. linked to shortages of mental health providers in counties

By Melissa Patrick

Kentucky Health News

Increased rates of youth suicide were linked to counties that have workforce shortages among mental health providers, according to a new study. 

The study, published in JAMA Pediatrics, found that after adjusting for demographic and socioeconomic characteristics, counties with a mental health workforce shortage designation were associated with an increased youth suicide rate and an increased youth firearm suicide rate when compared to counties with no or partial mental health shortage designations.

“Our results underscore the critical need to expand the mental health professional workforce in counties across the country,” lead author Dr. Jennifer Hoffmann, an emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a news release. “In addition, policies that restrict firearm access to young people may be considered as a suicide prevention strategy."  

Using youth suicide data from every U.S. county, the researchers found there were 5,034 suicides by youth between the ages of  5 and 19 from 2015 to 2016, with an annual suicide rate of 3.99 per 100,000 youth. The study found that among all the counties where a youth suicide occurred, more than two-thirds of them, or 67.6%, were designated as mental health workforce shortage areas. 

And for counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase in the score, says the report. 

Counties that are designated as a Mental Health Healthcare Professional Shortage Area by the U.S. Health Resources and Services Administration are further assigned a score that ranges between 0-25, with higher scores indicating greater shortages. 

The researchers also found that there were geographic disparities, with higher suicide rates in rural and high poverty areas, where mental health professionals are scarce. 

 "Counties with mental health HPSA designation had more uninsured children, lower educational attainment, higher unemployment, higher poverty, higher percentages of non-Hispanic White residents, and were more often rural, compared with counties with partial/no HPSA designation," they write. 

Hoffmann offered several ways to improve access to youth mental health care.

“Mental health workforce capacity can be increased through integration of mental health care into primary care settings and schools, and through expansion of telehealth services,” Hoffmann said in the release. “Improving reimbursement rates for mental health services may further aid in recruitment and retention of mental health professionals, and hopefully reduce suicide rates among young people.”

Dr. Aaron Carroll of the Indiana University School of Medicine and Denise Hayes of the university's School of Public Health, argued in an accompanying editorial that money directed at hiring more mental health care professionals alone will not solve this problem. 

"Even if the money was available, it would be nearly impossible to fix this problem through hiring alone," they write. "We have never valued mental health the way we do physical health. Of the more than $3 trillion we spend on health care each year, a pitiful amount is dedicated to behavior and psychiatric issues." 

The news release notes that mental health problems are among the most common precipitating factors for youth suicide. Further, it says that up to one in five children in the U.S. has a mental health condition, but only about half of children who need mental health care receive it.

  Rural Health Information Hub map

Suicide is the second leading cause of death among U.S. adolescents, with rates rising over the last decade. 

This is also true in Kentucky. And in 2022, every county in Kentucky is designated as a Mental Health Professional Shortage Area. 

"Countless youth need help," Carroll and Hayes write. "Unfortunately, help is often in short supply." 

According to the 2021 Youth Risk Behavior Survey, 19% of Kentucky's high school students seriously considered attempting suicide during the 12 months before the survey and 15% of them made a plan about how they would do it in that same time frame. And 9.5% of them said they had actually attempted suicide one or more times in the year prior to the survey. 

Further, firearm deaths among Kentucky children between the ages of 1 and 19 increased 83% between 2013-15 and 2018-20, from 3.6 to 6.6 deaths per 100,000, according to data published in the 2022 Kids Count County Data Book. 

Dr. Lindsay Ragsdale, chief medical officer for Kentucky Children’s Hospital, recently told Kelsey Souto with WKYT-TV that the hospital is seeing an influx of youth coming into the emergency department experiencing a mental health crisis, due to gaps in outpatient resources.

"I think we have to start talking to children in adolescence about what they’re going through,” said Ragsdale. “To make it okay, to say I’m not okay.”

SAMHSA photo

Kentucky's youth are asking for more mental health resources, according  to a Kentucky Youth Advocate survey that asked them what state leaders should prioritize. Some of their responses were included in the County Data Book. 

"Mental health should be a big priority. As someone that has anxiety and it affects me everyday not just mentally but also physically, it is the best feeling knowing that people really care about me and the way I feel," said 14-year-old Elizabeth from Daviess County.

Help is available for anyone who is thinking about suicide or knows someone who is considering it. To get help, dial 988, which is the new suicide and crisis lifeline. The three-digit mental health crisis hotline offers free, confidential support and is available 24 hours a day.

Read More

Parents are sending kids to school sick, citing need to work, concerns about missing more school and weariness as reasons

Schools in Kentucky and across the nation have been hit hard by a slew of respiratory viruses and some parents are sending their children to school sick or sending them back to school while still infected. 

Parents are citing an inability to take more time off work, concerns about their children missing out on in-class instruction and a weariness from dealing with so much illness during the pandemic, Alex Janin reports for the Wall Street Journal.

 In a typical year, Jackie Follansbee, a nurse in the Yakima School District in Yakima County, Washington told Janin that she would send two to three children a week back home for returning to school sick. Now, it’s two to three “repeat offenders” a day, she says.

Janin reports that schools across the country are sending notes to parents urging them to not send their children back to school until their child is fever-free for 24 hours without medication and symptoms are improving. And in some cases, nurses are calling families to remind them that symptoms of viral illnesses can last for a week or more.

Respiratory illness has been so bad in Kentucky that so far in November, 58 Kentucky school districts have closed or used non-traditional instruction days due to illness, impacting 186,500 students, according to the Kentucky School Boards Association.

And in Pike County, the school board has decided to amend its attendance policy to increase the number of parent notes that can be used for excused absences from school from five to 10, Kristi Strouth reports for the Appalachian News-Express. She adds that students will continue to be allowed unlimited doctor's notes to excuse their absences. 

In addition to an influx of respiratory syncytial virus, or RSV, Covid-19, and the common cold, Kentucky's latest influenza report shows that most of the 6,061 confirmed flu cases this year have been in children under the age of 10, followed by people between the ages of 11 and 20. 

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults. 

As of Nov. 19, about 16% of PCR tests for RSV in the U.S. were positive, an increase from about 7.5% at the same time last year, according to Centers for Disease Control and Prevention data collected from voluntary lab reporting. 

Further, the WSJ reports that as of the first week of November this year, children under the age of 18 were hospitalized for flu at the highest rate since 2009, according to CDC data.

Increased infection and the need for school-aged children to stay home until they are well is also impacting the workplace

"A new round of viral infections — flu, RSV, covid-19 and the common cold — is colliding with staffing shortages at schools and day-care centers to create unprecedented challenges for parents and teachers," Abha Bhattarai reports for The Washington Post. "More than 100,000 Americans missed work last month because of child-care problems, an all-time high that’s surprisingly even greater than during the height of the pandemic, according to new data from the Bureau of Labor Statistics." 

Old-fashioned public health measures help to decrease the spread of all of these viruses, including avoiding close contact with others when you are sick, covering your nose and mount when you cough or sneeze, keeping your hands washed and staying  home when you are sick and don't have fever for 24 hours without medication. 

Read More

State Sen. Ralph Alvarado, head of Senate health committee, will resign to become state health commissioner in Tennessee

State Sen. Ralph Alvarado

Republican state Sen. Ralph Alvarado, a Winchester physician who chairs the state Senate's Health and Welfare Committee, is resigning his seat to become health commissioner in Tennessee.

The office of Gov. Bill Lee said Alvarado will resign his seat before taking office Jan. 16. That indicates that the special election to succeed him will not be called by Democratic Gov. Andy Beshear, but by Senate President Robert Stivers, since the legislature will convene Jan. 3.

“It’s an honor to join Governor Lee’s team to advance health and prosperity for every Tennessean,” Alvarado said in a prepared statement. “I appreciate this opportunity and look forward to serving individuals and families across the Volunteer State.”

Read More

There is no vaccine for hepatitis C ; all adults should get tested

jarun011, iStock/Getty Images Plus

By Takako Schaninger

University of Kentucky  

The hepatitis vaccines you receive as a child don’t protect you from getting hepatitis C, a serious disease that can have fatal consequences including liver damage, cirrhosis and liver cancer.

Hepatitis is an inflammation of the liver most often caused by three viruses: hepatitis A, hepatitis B and hepatitis C. There is a vaccine for hepatitis A and hepatitis B, but not for hepatitis C. . 

Most people who get hepatitis C develop a chronic, long-lasting infection that sometimes doesn’t present symptoms for months or even years, meaning they can unknowingly spread the virus to others.

Millions of Americans have hepatitis C, yet many don’t know they are infected. The only way to know for sure is to get tested.

The infection is transmitted mainly by blood-to-blood exposure. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment used to prepare and inject drugs.

The Centers for Disease Control and Prevention estimates that 2.4 million people in the U.S. have chronic hepatitis C, with Kentucky having some of the highest infection rates in the country.

The CDC recommends that all adults get tested for hepatitis C. Getting tested is important to find out if you are infected and get lifesaving treatment. Treatments are now available that can cure most people with hepatitis C in eight to 12 weeks.

Kentucky Cabinet for Health and Family Services map

Hepatitis C is easily preventable. 

For people who inject drugs, the best way to prevent hepatitis C is to stop injecting. Drug treatment including buprenorphine can lower your risk for hepatitis C since there will no longer be a need to inject. 

However, if you are unable or unwilling to stop injecting drugs, there are steps you can take to reduce the risk of becoming infected including using new, sterile equipment for each injection and avoiding sharing equipment with others.

Kentucky currently has 82 syringe exchange programs in 63 counties. Click here to find their locations and hours. 

Read More

Provisional drug overdose data shows hopeful trend in Ky. and the nation, with numbers dropping in each of last three months

By Melissa Patrick
Kentucky Health News

Preliminary data suggests that drug-overdose deaths are declining in Kentucky and the nation. 

The Centers for Disease Control and Prevention's latest provisional overdose death data for the first six months of this year showed a 5.5% year-to-year increase in the number of predicted overdose deaths in the 12-month period ending June 2022, but the latest numbers are promising. 

Predicted provisional counts represent estimates of the number of deaths, with adjustments for incomplete reporting that always occurs. 

After reaching a high of 110,202 estimated U.S. overdose deaths in the 12 months ending in March, that number declined for each of the following three months. In the 12-month period ending in June, it had dropped to an estimated 107,582, down 2.4% from March. 

Centers for Disease Control and Prevention graph; click to enlarge

In Kentucky, the provisional report shows that there has been a steady, though slight, decrease in the number of estimated overdose deaths in all but one of the 12-month periods since September 2021.

The year-to-year decline in predicted overdose deaths from the 12 months ended June 2021 was 13, a decrease of 0.6%. 

But just like the rest of the nation, there has been a decrease in overdose deaths in the last three months, dropping from an estimated total of 2,372 in the 12 months ended in March to 2,299 in the 12 months ended in June. That 3% drop is slightly higher than the national average. 

"Today's data continue to show a hopeful trend of a decrease in overdose deaths," but more work is needed for "expanding care for substance use disorder, making naloxone more accessible and dismantling drug trafficking operations," Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, said in a statement. 

Centers for Disease Control and Prevention graphic; click to enlarge

The report also includes data about drug-overdose deaths by drug or class of drugs. In Kentucky, it shows that in the 12-month period that ended in June 2022, natural opioids were involved in 1,830 of the reported deaths and synthetic opioids such as fentanyl were involved in 1,673 of them. 

People who are struggling with drug abuse or who are concerned about a family member's substance use can search for treatment providers at www.findhelpnowky.org.

Read More

Only 10 Kentucky counties are at medium risk of Covid-19 and the rest are at low risk, but flu and RSV levels remain high

Centers for Disease Control and Prevention map, emphasizing Kentucky

By Melissa Patrick
Kentucky Health News

In the best Covid-19 report Kentucky has seen in a long while, the latest Centers for Disease Control and Prevention's national risk map says only 10 Kentucky counties, all in the east, are at medium risk of the disease, and the rest of the state is at low risk. 

The medium-risk counties on the risk map, shown in yellow, are Greenup, Carter, Boyd, Lawrence, Martin, Johnson, Magoffin, Floyd, Pike and Letcher. Low risk counties are shown in green. 

The CDC says people in yellow counties who are immunocompromised, or at high risk for severe illness from the virus, should talk to a health-care provider about whether they need to wear a mask or take other precautions.

The New York Times ranks Kentucky's infection rate 36th among the states, with a 54% drop in cases in the last two weeks.

CDC map, emphasizing Kentucky; click to enlarge

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 four Kentucky counties at low levels of transmission, 25 at moderate levels and the rest have either substantial or high levels. This transmission data is largely used by researchers and health-care facilities. 

State health officials have encouraged Kentuckians to use the other CDC risk map, which includes both cases and hospital data to determine risk, to guide their preventive measures. 

Meanwhile, influenza and RSV cases remain high. RSV stands for respiratory syncytial virus, a common virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults.

At his weekly news conference Thursday, Gov. Andy Beshear again urged Kentuckians to get their annual flu vaccine and Covid-19 booster shot, noting that the spread of these respiratory diseases is so bad that the state's pediatric hospitals are filling up, pediatric intensive-care beds are almost full, and schools have had to close because so many viruses are going around.  

"If we want to protect against this, and we don't want to have to cancel days, we recommend getting your flu shot and getting boosted for Covid," Beshear said. "The Covid booster provides protection against Omicron [variants] out there. And approaching the holidays, where we're gonna get our youngest Kentuckians that are at risk of RSV and our oldest Kentuckians that are at most risk of Covid all coming together with the rest of us -- let's just do what it takes to protect them."

Read More

Most Kentucky hospitals in national patient-safety ratings got C grades again; state ranks 36th among states in share of A ratings

By Melissa Patrick
Kentucky Health News

Most of the 60 Kentucky hospitals graded on a nonprofit group's report card for patient safety got a grade of C when.

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small and are not rated.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave A ratings to 11 Kentucky hospitals, or 18.3% of the 60 it graded; Kentucky ranked 36th among states in the percentage of A grades, about the same as 35th in the last report. It gave Bs to 16 Kentucky hospitals, Cs to 23 and Ds to 10. 

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections, and whether hospitals have systems in place to prevent them. 

A Leapfrog news release notes that this is the 10th anniversary of the Leapfrog Hospital Safety Grade report and that an analysis of data gathered from 2012 to 2022 suggests there has been an improvement in patient safety over time, with a 27% decrease in falls and trauma, and a nearly 29% decrease in objects being unintentionally left in bodies after surgery. Further, it found decreases in infections associated with health care.

"For five of the outcome measures that can be tracked, these improvements saved an estimated more than 16,000 lives over the 10-year period," the release says.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation. 

The Leapfrog site offers details on a number of measures, under headings titled Infections, Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

Screenshot of Leapfrog page for AdventHealth Manchester, which moved up  to an A from a C. 

High Scores

Hospitals getting As were: Advent Health Manchester; Baptist Health Lexington; Baptist Health Richmond;  Clark Regional Center in Winchester; Deaconess Henderson Hospital; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children's Hospital; St. Elizabeth Healthcare-Ft. Thomas; and Lebanon's Spring View Hospital. 

AdventHealth Manchester moved up from a C on the last report, Clark Regional Center moved up from a B on the last two, and Spring View Hospital got its first A ever. The rest maintained their A grades. 

Baptist Health Lexington has received an A grade for 10 consecutive grading periods, and and Baptist Health Richmond has received an A for five consecutive grading periods.  

This is the seventh straight grading period that all four Norton Healthcare adult-service hospitals in Louisville have received an A.

“By working together and keeping the safety of our patients — and each other — at the center of all they do, Norton Healthcare’s employees consistently do the hard work that is necessary to receive ‘A’ Leapfrog Hospital Safety Grades,” Russell F. Cox, president and CEO of Norton Healthcare, said in a news release. “Seven consecutive ‘A’ grades is no small feat, and I am honored to lead this exceptional team." 

Shifts up and down

After receiving four Cs in a row, preceded by nine Ds, University of Louisville Hospital rose to a B on the latest report.

"Improved data reporting, and other initiatives, implemented since UofL Health’s formation are beginning to show positive direction," UofL Health said in a statement. " As the first hospital in the system, UofL Hospital’s rising grade is an early indicator of more to come. . . . For our other facilities, the grades issued by Leapfrog reflect data that lags by several years and continue to include years of previous ownership groups." 

Other U of L hospitals graded by Leapfrog were UofL Health Shelbyville Hospital (B), UofL Health-Sts. Mary and Elizabeth Hospitals (C), and Jewish Hospital (C). 

Meadowview Regional Medical Center in Maysville moved up to a B after receiving two Cs in a row, as did Saint Joseph Hospital in Lexington, after getting four Cs in a row and Lexington's UK HealthCare Good Samaritan Hospital after getting five Cs in a row. 

Two Kentucky hospitals moved from an A grade on the last report to a C grade: Mercy Health Lourdes in Paducah and Monroe County Medical Center. Baptist Health Corbin moved from an A to a B.  

Baptist Health Paducah moved down to a C from a B, after having received only one C grade since fall 2018, and Owensboro Health moved down to a C after receiving only As and Bs since spring 2018. 

Other hospitals that moved from a B to a C were Frankfort Regional Medical Center and TJ Sampson Community Hospital in Glasgow. 

Five hospitals moved from a C grade down to a D grade. 

Flaget Memorial Hospital in Bardstown moved down to a D from a C, after having received all As and one B since Fall 2019. 

Harlan ARH Hospital moved down to a D after receiving seven Cs in a row, and Hazard ARH Regional Medical Center got a D after getting two Cs in a row. 

Jackson Purchase Medical Center in Mayfield moved down to a D after getting seven Cs in a row. 

The other five hospitals with D grades are Jennie Stuart Health in Hopkinsville, Murray-Calloway County Hospital, Pikeville Medical Center, St. Claire Regional Medical Center in Morehead, and Taylor Regional Hospital in Campbellsville. Each also got a D on the last report. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded.

Read More

Colorectal screening now available at participating Ky. pharmacies

L-R: Brooke Sorgi of Exact Sciences, maker of Cologuard, a

DNA-based screening test, and Capital Pharmacy pharmacist

Dr. Emily Wilkerson mark the first pharmacist-led colorectal

cancer screening via a stool-based test on Sept. 29.

Kentucky's pharmacists and health insurers have teamed up to offer what they say is the nation's first "pharmacist-led colorectal cancer screening via a non-invasive stool-based test."

The test was done Sept. 29 at Capital Pharmacy & Medical Equipment in Frankfort, the Kentucky Pharmacists Association and the Kentucky Association of Health Plans said in a Nov. 17 news release.

“Health plans and pharmacists are joining together to tackle a leading cause of death in the commonwealth,” KAHP Executive Director Tom Stephens said.

KAHP gave the Kentucky Pharmacists Education and Research Foundation a $50,000 grant to expand access to these screenings in Kentucky. Participating pharmacies are being reimbursed for pharmacist-led screening and follow-up.  

KPA Executive Director Ben Mudd said, “Adding assessment of and screening for colorectal cancer to existing pharmacy protocols can greatly impact our two-decade-long fight to increase CRC screening rates. With early detection, colorectal cancer is a preventable, treatable, and beatable disease.”

The screenings were authorized by a new protocol approved by the Kentucky Board of Pharmacy in September 2021. It lets pharmacists initiate dispensing of noninvasive, stool-based colorectal cancer screening such as a fecal immunochemical test or a stool DNA test. Pharmacies interested in providing the service can contact Dr. Emily Wilkerson at fellow@kphanet.org for more information.

Read More

As you spread the spirit of the holidays, don't spread sickness; shots reduce chance of flu and long Covid-19 by about 50%

By Ben Chandler
President and CEO, Foundation for a Healthy Kentucky

Holiday cheer won’t be the only thing spreading this season. As the weather cools and people start spending more time inside where viruses can easily spread, the risks of illness are high.

This winter, public health officials expect heavy traffic in urgent and primary care offices, increased hospitalizations, and more Kentuckians’ suffering from the long-term effects of Covid-19. More than two dozen school districts across the commonwealth have closed or moved to remote learning due to “widespread illness” already this November.

Kentucky families are dealing with flu, RSV (respiratory syncytial virus), Covid-19 and other respiratory illnesses. While most healthy people may bounce back in a few days or weeks, older people and those with compromised immune systems are at risk for potential hospitalization and death.

Ben Chandler

Although new Covid-19 variants might not be as deadly, the long-term effects could be devastating. The American Academy of Physical Medicine estimates nearly a half million Kentuckians are suffering from "long Covid." Symptoms include brain fog, problems sleeping, prolonged loss of taste and smell, increased likelihood of depression, heart, respiratory, gastrointestinal, and kidney issues, as well as skin rashes and hair loss. As more research is done, we continue to discover the brutal long-term effects on people.

Now for the good news. We know that Kentuckians who are up to date on their immunizations are less likely to develop long Covid or severe flu. People who have received a Covid-19 vaccine and boosters are 50 percent less likely to develop long Covid if they contract the virus. An Italian study found after a third dose of an mRNA vaccine, the odds of long Covid fell to 16 percent.

A seasonal flu shot reduces a person’s risk of sickness by 40 to 60 percent. That means less chance of having to go to the doctor, taking days off work, or missing family events or your kids’ activities. A 2021 study showed among adults hospitalized with flu, vaccinated patients had a 26 percent lower risk of being admitted to an ICU and a 31 percent lower risk of death from the flu.

Research shows the Covid-19 vaccines and boosters, as well as flu shots, are safe. While some people may have short-term side effect such as a sore arm, headache, or fatigue after receiving their vaccines, the risk of getting sick with Covid or flu without being up to date on immunizations are far greater.

Covid-19 has already taken enough from all of us. Let’s not let it ruin yet another holiday season. We encourage you to have a conversation with your doctor about getting your seasonal boosters. By doing so, you might be able to avoid long hours in crowded urgent care and emergency rooms, hospitalization, or canceled holiday plans with your loved ones.

Read More

Anthem expands its rural health scholarship program at EKU

Anthem Blue Cross and Blue Shield's Kentucky Medicaid unit is expanding its rural scholarship program at Eastern Kentucky University "to grow the number of frontline workers in the eastern region of the state and increase access to care and improve health equity for those living in Kentucky’s rural areas," the company and the university said in a press release.

The fund of nearly $200,000 "will enable more students to provide care in underserved communities," the release said. "Anthem Medicaid launched the scholarship in August 2021, granting eight students the opportunity to pursue health education and eventually serve in Eastern Kentucky." This year’s scholarship recipients are Breanna Goble, a Johnson County native, and Sara Cornelison, a Madison County native.

In the Kentucky Hospital Association’s 2022 Workforce Survey Report, Kentucky hospitals reported more than 13,000 vacancies across 13 professional groups last year. "Nursing topped the list with 22% of all nursing positions unfilled, and another 14% of nurses near retirement," the release noted. 

Read More

Using his pardon power, Beshear lets people with certain certified health conditions possess up to 8 ounces of medical marijuana

Beshear displayed a map showing in green the adjoining states where medical cannabis is legal.

By Al Cross
Kentucky Health News

Kentuckians who meet a detailed set of requirements would be able to possess up to 8 ounces of marijuana for medical use starting Jan. 1, under an executive order Gov. Andy Beshear signed Tuesday.

The drug would have to be bought in a state where the sale of cannabis is legal, and the person would need the receipt and a certification from a health-care provider saying that they have at least one of 21 specific conditions, including cancer, epilepsy, Parkinson's disease, Crohn's disease, sickle-cell anemia, severe and chronic pain, post-traumatic stress disorder, fibromyalgia, glaucoma or a terminal illness.

Beshear's order is in the form of an advance, conditional pardon. He had not mentioned such a device in his seven months of public deliberation about the issue, which began when the state Senate again refused to hear a House-passed bill to legalize medical cannabis. Republicans control both chambers.

The highest-quality health care is a human right," the Democratic governor asserted. Noting that Kentucky has high rates of cancer and painkiller overdoses, he said "There's another way to manage the pain without the threat of addiction."

Beshear created a Medical Cannabis Advisory Committee that held several public hearings on the issue. It received more than 3,500 comments, 98.6% of which favored of legalizing medical cannabis, he said.

"Kentuckians are leaving this state to access medical cannabis," he said. "Some of them are leaving this state for good." The drug is legal in 37 states.

One commission member, Justice Secretary Kerry Harvey, said cannabis is "a treatment that's already available to the overwhelming majority of Americans but not Kentuckians," some of whom have declined to use the drug because they don't want to violate the law: "What an awful choice that must be."

Jared Bonvell, a veteran from Northern Kentucky, said his use of cannabis gave him "a change of life that is just absolutely astounding," allowing him to stop taking 13 medications.

Paducah contractor Craig Manley said in a video that nothing took away his pain except THC, the psychoactive ingredient in cannabis.

State and federal law define marijuana as containing Delta-9 THC. Products containing Delta-8 THC, a less potent form, are on the market legally. Beshear signed another order regulating Delta-8 THC and said it would provide the legal framework for regulating cannabis if the legislature legalizes it.

Beshear's cannabis order notes that 8 ounces is the most marijuana that can be possessed under Kentucky law without being a felony, and says the health-care provider's certification "shall not constitute a prescription for medical cannabis."

The order allows the cannabis to be possessed by a caregiver, defined as someone at least 21 and with "significant responsibility for managing the well-being of the individual on whose behalf the cannabis was purchased."

"Today's actions are not substitutes for much-needed legislation," Beshear said. "What we're trying to do is take a measured step to help those who are struggling."

John Cheves of the Lexington Herald-Leader reports, "There may yet be legal challenges to Beshear’s actions. House and Senate leaders did not immediately respond to requests for comment Tuesday. But the office of Republican Attorney General Daniel Cameron, who often clashes with Beshear, said he’s studying the orders."

Read More

$35 cap on seniors' monthly insulin costs isn't reflected in online 'plan finder' that is used by Medicare members to choose a plan

Screenshot of Medicare plan finder; for the web page, click here.

By Susan Jaffe
Kaiser Health News

A big cut in prescription drug prices for some Medicare beneficiaries kicks in next year, but finding those savings isn’t easy.

Congress approved in August a $35 cap on what seniors will pay for insulin as part of the Inflation Reduction Act, along with free vaccines and other Medicare improvements. But the change came too late to add to the Medicare plan finder, the online tool that helps beneficiaries sort through dozens of drug and medical plans for the best bargain.

Officials say the problem affects only 2023 plans.

To fix anticipated enrollment mistakes, Medicare officials will give beneficiaries who use insulin a chance to switch plans next year. They can make one change after Dec. 8 and throughout 2023 through a special enrollment period for “exceptional circumstances.” Typically, people are locked in for an entire year.

The Centers for Medicare & Medicaid Services provided initial details of the opportunity in a document distributed to the State Health Insurance Assistance Program, or SHIP, which assists Medicare enrollees in every state. Although Medicare did not publicize the document, beneficiaries can get more information by contacting their local SHIP office. CMS officials would not answer questions about whether the ability to change plans will be granted automatically.

In some cases, a special enrollment period can be avoided, said Janet Stellmon, director of the Montana State Health Insurance Assistance Program. If the plan charges more than a $35 copayment for a member’s insulin, a SHIP counselor can ask the plan to correct the mistake. “Plans usually try to make it right quickly,” said Stellmon, who helped one beneficiary save $565 a month on insulin.

Medicare patients spent $1 billion in 2020 on insulin products — four times the amount in 2007, with some paying as much as $116 a month out-of-pocket, KFF has found. Americans paid an average of five to 10 times as much for insulin in 2018 than in other countries, according to a recent study. About 3.3 million people with Medicare rely on one or more insulin products to control blood sugar levels.

The $35 copay for injectable insulin products takes effect Jan. 1, and July 1 for patients who use an insulin pump.

When beneficiaries who use insulin now check the plan finder, the price could show up as thousands of dollars a year instead of the maximum $420 stipulated by law. An inaccurate price could also distort the costs of other drugs, which depend on what coverage phase patients reach. For example, once both the plan and the patient spend a total of $4,660 for all drugs next year, the member pays no more than 25% of the cost for non-insulin drugs.

It’s extremely difficult for consumers to evaluate policy options without the plan finder. One plan might have the lowest price for one drug but not another. Or a plan might have the lowest premium but higher drug prices. Or a preferred pharmacy in one plan may be excluded in another.

The finder does display a warning: “This new $35 cap may not be reflected when you compare plans. You should talk to someone for help comparing plans.” It points readers to the Medicare help line — 800-633-4227 — or a counselor with SHIP.

It doesn’t mention the option of changing plans after the Dec. 7 enrollment deadline, but both SHIP counselors and representatives answering the Medicare help line rely on the same flawed plan finder.

Drug plans do not have to cover all injectable insulins, said Tatiana Fassieux, an education and training specialist at California Health Advocates. “It’s all about the formulary,” she added, referring to the list of drugs covered by a plan.

Read More

Time for pharmacy-benefit managers to 'share the savings' in prescription-drug costs, crusaders against diabetes write

Read More

Flu off to fast start; cases keep more than doubling each week in Kentucky; flu, Covid-19 and RSV threaten a 'triple-demic'

State Dept. for Public Health map, adapted by Ky. Health News; county figures are online here.

Last week's cases will
be reported on Friday.

By Al Cross
Kentucky Health News

Influenza is spreading quickly in Kentucky, raising the threat of a "triple-demic" of flu, Covid-19 and respiratory syncytial virus (RSV).

The state Department for Public Health's most recent report says 2,082 flu cases were confirmed during the week that ended Nov. 5. That was 140 percent more the the previous week, and case numbers the week before were more than triple the previous week. All told, 3,342 cases have been confirmed, and that does not include at-home tests.

Most of the cases have been in Kentuckians 20 and younger. Flu and other respiratory viruses have been so widespread that many school districts have closed schools or moved to nontraditional instruction for a few days.

Kentucky Department for Public Health graphs

Last Monday, 25 of the 171 public districts did; the following day was Election Day, when most were scheduled to be closed anyway for voting.

"More than 100,000 Kentucky students have been sent home this month, and health professionals are warning more closures are likely, saying there is a strong possibility of a "tripledemic" this winter," reports Krista Johnson of the Louisville Courier Journal. "For the past two years, safety measures related to Covid-19 have kept influenza and RSV case numbers low, but hospitalizations due to these viruses are increasing."

The state has confirmed one death from the flu, in an adult.

The flu is getting off to a faster start than usual. The percentage of clinic visits resulting in reports of influenza-like illnesses is higher than it has been in any of the last four years, according to a health department graph.

Dept. for Public Health graph; MMWR is the CDC's Morbidity and Mortality Weekly Report 

Read More

Had trouble with a health-insurance claim? An appeal? National, nonprofit newsroom ProPublica wants you to help its reporting

Photo illustration from ProPublica

ProPublica, the national, nonprofit, investigative newsroom, wants Americans to help it report why health insurance claims are denied, what the consequences are for patients, and how the appeal process works. It says it has heard from hundreds of people about the obstacles they have faced when denied health care.

"Take Alyssa Miller, a hospital-based nurse," ProPublica reports. "When she was 16, she was diagnosed with cancer and had to undergo radiation treatment. Given her now-increased cancer risk, her oncologist said she’d have to get a mammogram by 25. But when she went to get the procedure, Miller’s insurer denied her claim because, per its policy, it only covers mammograms when patients are 40 or older. She fought back with an appeal backed by a note from her doctor. That was denied, too."

Miller told ProPublica, “I was just really frustrated and confused by the whole appeals process. I feel like I’m supposed to know how this works being a health care provider. I almost gave up.”

Miller was able to get her mammogram covered by asking her employer’s human-resources office to get involved, ProPublica reports, "but she is among just a small percentage of people who appeal these denials. . . . Even insurance company employees, doctors and nurses have to battle insurers for coverage for themselves and their family members."

ProPublica said it has heard from "more than 100 people who work in health care or insurance and have had difficulty getting care covered, including:

• A doctor whose son has a speech disorder but had to stop speech therapy because insurance would not cover it.
• A nurse practitioner with long COVID whose treatments are being denied by insurance.
• An ophthalmologist whose uncle had a detached retina, which can cause blindness without treatment. The insurer denied the surgery because it concluded the procedure was not emergent.

Now we are hoping to hear from more people who can help us understand what is happening on the inside as these decisions are made. If you or someone you know works in health insurance, please fill out this form." If not, use the link in the first paragraph of this story.

Read More

Nov. 17 is American Cancer Society's Great American Smokeout

CDC graphic

By Melissa Patrick

Kentucky Health News

The American Cancer Society's annual Great American Smokeout, a day when smokers are encouraged to quit for the day and make a plan to quit for good, will be observed Thursday, Nov. 17. 

"The Great American Smokeout is more than a reminder of the dangers smoking poses to your health," says the Centers for Disease Control and Prevention. "It’s a call to act. No matter your age, or how long you’ve been smoking, quitting improves health both immediately and over the long term." 

Cigarette smoking continues to be the leading cause of preventable death in the United States and Kentucky, killing 8,900 Kentuckians a year. Nationwide, it kills more than 480,000 people, which is nearly one in every five deaths, says the CDC. 

Kentucky's smoking rates have steadily decreased for years, but the bad news is that nearly one in five Kentucky adults, or 19.6%, still smoke; 41% of Kentucky smokers said they had tried to quit in the last year, according to the 2021 Behavioral Risk Factor Surveillance System survey, a national CDC poll. 

The CDC says quitting smoking is one of the most important actions people can take to improve their health and offers a detailed list of the health benefits, including longer life, lowers risk of 12 types of cancer, lowers risk of heart and lung disease, and lower risk of poor pregnancy outcomes.  

Kentucky smokers have a number of tools to help them quit. The state runs a 1-800-QUIT-NOW hotline that offers free tobacco-cessation services. 

"The coaches at Quit Now Kentucky can help you make a plan to quit, manage nicotine cravings and get back on track if you have setbacks. Some people even are eligible for free nicotine-replacement therapy like nicotine patches, gum or lozenges," according to the state Cabinet for Health and Family Services webpage. 

And while Quit Now Kentucky provides free services to people of all ages, middle- and high-school students may want to try "My Life, My Quit," a free, confidential quitline for Kentuckians 17 and younger to help them stop smoking or vaping. Teens can text "Start My Quit" to 36072, or click on the live chat button on the My Life, My Quit website to chat with a coach.    

A 2017 law requires insurers, including Medicaid, to cover all seven tobacco-cessation medications approved by the U.S. Food and Drug Administration, and counseling services recommended by the U.S. Preventive Services Task Force. It also eliminated co-payments for medication and counseling, requirements tying medication coverage to counseling, and limits on length of treatment.

The American Cancer Society also offers a list of resources to help you quit using tobacco products.

Read More

Map estimates how ready your county is to help with recovery

Screenshot, adapted by Ky. Health News; for the interactive version, click here.

By Liz Carey
The Daily Yonder

When officials in Vine Grove put out a vending machine filled with free opioid-overdose reversal medication, they expected people in the 7,000-person strong community would use it.

They just didn’t anticipate it being empty three days later.

“We put one machine out 27 days ago,” said Keith Mattingly, police chief of Vine Grove, located near Fort Knox about 25 miles southwest of Louisville. “Since then, we’ve gone through 169 boxes of Narcan.”

Narcan is a nasal spray version of Naloxone that reverses the effects of an opioid overdose. Giving it to an overdose victim can revive them within minutes.

In 2021, 2,250 Kentucky residents died of drug overdoses, a 14.5% increase over the previous year, the state’s Office of Drug Control Policy said. That includes 46 deaths in Hardin County, which includes Vine Grove. The increasing number of deaths in his community spurred Mattingly to do something.

“I’m just out to save some people’s lives,” Mattingly told the Daily Yonder.

The Narcan vending machine is one example of how rural areas are addressing the drug use epidemic. A new national index from the Center for Rural Health Research at East Tennessee State University called the Recovery Ecosystem Index Mapping Tool drills down to the county level to assess drug recovery systems across the country.

Each county has a composite of the information that goes into its index score. That includes information on substance-use-disorder treatment options, care that recovering people receive after initial treatment, and social indicators such as broadband access, number of vehicles available, and other factors.

The mapping tool, created in association with the National Opinion Research Center at the University of Chicago and the Fletcher Group, a consultancy, shows the recovery resources available in every county in the United States. The index then rates each county by comparing resources and demographic information against the county’s overdose mortality rates.

“The index is intended to serve local stakeholders to help them better understand the availability of recovery-related resources in their county and neighboring counties,” Andrew Howard of the Fletcher Group said in an email interview.

Researchers hope the index can also be used to develop best practices for use in other communities, as well as be used by policymakers to better understand how services are distributed, and how they can target counties that lack resources.

“We are hoping that people at the community level will use this tool to first determine the recovery ecosystem score for their community, but then to dig into the data to really understand where they can invest to create a better support system for their people,” said Michael Meit, co-director of the Center for Rural Health Research and one of the researchers on the project.

Meit said they found certain rural areas had greater success building out that recovery infrastructure. Although rural areas face more obstacles, he said, some are providing a better support system for their residents.

“To some extent, we expect to see lower scores in rural areas,” he said. “At the same time, there are places that do very, very well – in particular, Eastern Kentucky.”

There, the recovery ecosystem included access to harm-reduction programs, a network of support programs, and engagement with the criminal justice system and other groups to support recovery, he said.

“Rural areas, I think, have more structural challenges, but (building a recovery ecosystem) is still eminently achievable in rural areas,” he said.

Former Kentucky governor Dr. Ernie Fletcher, founder and chief medical officer for the Fletcher Group, said the recovery index would help communities across the country access detailed information on how to work more effectively and more efficiently.

“This will be a game-changer for recovery allies all across the country,” Fletcher said in a statement. “That’s especially important because recovery ecosystems involve so many moving parts and rely so heavily on local resources. Having a quick, accurate, and detailed snapshot of what’s available—and what’s missing—will be a godsend, especially in the rural communities we serve.”

While the index was released in September, and missed the addition of Hardin County’s vending machine, Meit said researchers anticipate updating the index regularly.

In Hardin County, officials are getting a first-hand look at what a successful overdose reduction program looks like. Who is taking the vending-machine Narcan? Mattingly said it varies.

“I’ve talked to elderly people who have addicted grandchildren,” Mattingly said. “They want to have it in case their grandchild overdoses at their house. We’ve had electrical contractors who’ve gotten them in case they come across someone overdosing when they go to a house. Are addicts coming to get them? There’s no way for us to know for sure, but I would assume so.”

So far, it looks like overdoses are down in the community, but he wasn’t going to draw conclusions until he had more data to compare it to, he said.

For now, though, he’s waiting until he can document one of his specially marked Narcan doses was used to reverse an overdose. Then, he said, he’ll know he’s done what he set out to do – save a life.

Read More