CDC's Kentucky risk map looks about the same as last week, but Beshear says 'Covid is definitely increasing' and counsels caution

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Robert Slaton dies at 81; was a catalyst for many health projects, including Passport Health Plan and Kentucky Health News

Robert Slaton, Ed.D.

Robert Slaton, a former Kentucky public-health commissioner and health-care consultant who was a catalyst for various health-improvement projects in the state, including Passport Health Plan and Kentucky Health News, died Dec. 27 after suffering a stroke a few days earlier. He was 81 and lived in Louisville.

Slaton, who had master's degrees in education and social work and a doctorate in educational administration, was state health commissioner in 1978-79, then ran the Public Service Institute at Kentucky State University and was external-affairs administrator for Trover Clinic, now Baptist Health Deaconness Madisonville, his hometown, from 1983 to 1989. While at the University of Louisville, he was Gov. Brereton Jones' special assistant for health-care reform, executive director of the university's primary-care center, executive director of the Medical School Practice Association and executive vice president of University Health Care, retiring in 2007. As primary-care director, Slaton was part of a small group that planned, developed, and implemented Passport Health Plan, which started in 1997 and became a national model for managed care of Medicaid patients.

As a member of the national advisory board of the Institute for Rural Journalism and Community Issues at the University of Kentucky, he was the catalyst for funding of the institute's Kentucky Health News by the Foundation for a Healthy Kentucky. Sitting with Institute Director Al Cross and then-Foundation President Susan Zepeda at a Kentucky Chamber of Commerce luncheon in 2010, he said, "Al, you ought to ask Susan for some money." When Zepeda asked what the money would be for, Cross (who had no idea the proposition was coming) replied that the goal would be improving health coverage in Kentucky news media. The foundation continues to fund Kentucky Health News.

Slaton later chaired the advisory board, helping the Institiute develop a strategic plan. He was a member of the foundation's Community Advisory Council and chair of the chamber's Health Care Policy Council. In 2018, he won the Russell E. Teague Award from the Kentucky Public Health Association for his achievements and contributions to public health.

"Throughout his career in both public service and as a health-care consultant, he provided a politically savvy perspective and an astute management style that enabled institutions and organizations to make significant headway in policy change to improve the health of Kentuckians," his obituary says. "Robert always believed that health care was a right, not a commodity, and he worked very hard in a variety of settings to help move it in that direction."

As health commissioner, "He demonstrated an understanding of social and structural determinants of health that was ahead of its time," the obituary says. "Robert was a consensus builder and a natural organizer who was described as generous and down-to-earth. His talents included problem solving, strategic planning, and organizing a group of people to get a project done. He was proud that over his career he had helped young staff members develop beyond what they thought they could do. He could often see what needed to be done before most people, and he could handle personalities and egos to bring about change in organizations. Robert focused much of his career on building linkages and coalitions between different groups. This was eased by his genuine rapport with people. Robert’s strategic planning skills, insightful opinions, and wise counsel were valued by many leaders in the business, nonprofit, and political world."

He was co-author of two books about management, From Green Persimmons to Cranky Parrots, and Caught in the Middle Management. At the time of his death, he was working on a book about his mother’s life, based on the diaries she kept for decades. As he moved into assisted living, Robert was already making plans for his next book, stories of his colorful adventures as a parole officer in Western Kentucky in the 1960s. He was a delegate to the 1992 Democratic National Convention.

Slaton is survived by five adult children, Andrea, Lyle, Tom, Danny (Elizabeth), and Mike (Jake), and three grandchildren: Thia, Henry, and Lila. He is also survived by his companion, Mary B. Bradley, and her two children, whom he very much thought of as his own: Lizi Hagan and Clay McClure.

A memorial service will be held at 10 a.m. ET Saturday, Dec. 31 at Pearson’s, 149 Breckenridge Lane, Louisville. Visitation will be held from 4 to 7 p.m. ET Dec. 30 at Pearson’s. In lieu of flowers, donations may be made to Down Syndrome of Louisville, the Foundation for a Healthy Kentucky, or the Institute for Rural Journalism and Community Issues.

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As he leaves public office, Dr. Anthony Fauci says the biggest change in public health has been the normalization of falsehoods

Dr. Anthony Fauci (Associated Press photo by Alex Brandon)

As Dr. Anthony Fauci retires after five decades in public health, he says he worries that lies and misinformation are creating a "profoundly dangerous" time for science and the public.

"Untruths abound and we almost normalize untruths," Fauci told The Associated Press. "I worry about my own field of health, but I also worry about the country."

Fauci has made the same point in several other exit interviews. In August, he said on MSNBC, "There's no much lying going on over there that people accept it as part of the norm," and when lots of people accept it as truithful, "that is the beginning, I believe, of the destruction of our democracy."

In December, he told ABC News, "Misinformation and disinformation is really hurting so many things, including people's trust in science. It becomes very difficult to get people to fully appreciate the truth of what's going on — which will ultimately impact how we respond, in this case, to a pandemic, like Covid-19."

AP notes, "Fauci, who turned 82 on Christmas Eve, has been a physician-scientist at the National Institute of Allergy and Infectious Diseases for 54 years, and its director for 38 of them. Because he candidly puts complex science into plain English, Fauci has advised seven presidents, from Ronald Reagan to Joe Biden, about a long list of outbreaks -- HIV, Ebola, Zika, bird flu, pandemic flu, even the 2001 anthrax attacks."

Fauci said his policy has been to "stick with the science and never be afraid to tell somebody something that is the truth -- but it's an inconvenient truth in which there might be the possibility of the messenger getting shot/ You don't worry about that. You just keep telling the truth. That's served me really quite well with one exception that, you know, the truth generated a lot of hostility towards me in one administration."

AP sums up: "As the world enters another year of Covid-19, Fauci still is a frequent target of the far right -- but also remains a trusted voice for millions of Americans. . . . The public did struggle to understand why some of his and others' health advice changed as the pandemic wore on, such as why masks first were deemed unnecessary and later mandated in certain places. Fauci said one of the pandemic's lessons is to better convey that it's normal for messages to change as scientists make new discoveries.

"That doesn't mean you're flip-flopping," he said. "That means you're actually following the science."

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Poll of rural Americans finds them more aware of, and more willing to discuss, opioid problems; 47% still see stigma

Morning Consult graph: 2017 and 2022 responses to question about access to care. Click to enlarge.

Rural Americans say they are more aware of, and more willing to talk about, the opioid problem in the nation and their communities than they were five years ago, according to an online poll of rural adults sponsored by the American Farm Bureau Federation and the National Farmers Union.Sixty percent said adults are more aware of the crisis than they were five years ago, and 77% said they would comfortable having a conversation about opioids, but 47% said there is stigma or shame associated with opioid abuse in their community.

Rural adults increasingly regard drug addiction as a disease. Asked if addiction to opioids is a disease or is due to a lack of will power or self-control, 57% said it's a disease and 21% said otherwise. In 2017, the numbers were 46% and 26%, respectively. Likewise, 78% said someone can accidentally or unintentionally get addicted to opioids; five years ago, 71% said that.

The poll found that more rural adults than five years ago believe there is a higher rate of opioid misuse in rural communities than in urban and suburban areas), and 48% said they know someone who is or has been addicted to opioids or prescription painkillers.

Asked if they had taken an opioid or prescription painkiller without a prescription, 5 percent said yes. The same percentage said they had abused opioids or prescription painkillers or been addicted to them. Asked how comfortable they would feel talking about that, 70% said they would feel very or somewhat comfortable discussing it with friends, 52% with siblings and 46% with parents. Beyond their immediate families, most said they would be not too comfortable, or not comfortable at all.

The margin of error for that subsample of 110 people is plus or minus 9.3 percentage points. The error margin for the whole sample of 2,010 rural adults is 2.2 percentage points. The poll was conducted online Oct. 6-13 by Morning Consult and the results were weighted to reflect gender, age, race, ethnicity, census region and education. The results are available from Farm Bureau here.

Farm Bureau and NFU, long rivals in representing farm interests, "have consistently worked to publicize and compile useful material to help address rural stress, mental health challenges and opioid misuse," they said in a press release. NFU President Rob Larew said, “We must continue to reduce the stigma to connect our loved ones with health care and treatment they may need. I thank AFBF for being a teammate on this project, and the survey results show what is possible when farm organizations work together.”

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More than 1/3 of Kentuckians are enrolled in Medicaid. How many in your county? How many kids? What are their big health issues?

Screenshot of health portion of Cabinet for Health and Family Services report on Clay County

By Al Cross

Kentucky Health News

Most Kentuckians probably don't know much about Medicaid, but for more than one in three people in the state, it is a lifeline. In some counties, more than half the residents are Medicaid beneficiaries. But Medicaid runs somewhat under the radar, because many Kentuckians frown on the receipt of public assistance -- even though Medicaid benefits come only with demonstrated medical need.

Medicaid is a combined federal-and-state program, created in 1965 by the law that created Medicare. Originally it was for the very poor, the disabled and the pregnant, but in 2014 expanded to households with incomes up to 138 percent of the federal poverty level because then-Gov. Steve Beshear embraced the 2010 Patient Protection and Affordable Care Act, better known as Obamacare.

The federal government pays 90 percent of the cost for people covered by the expansion, and about 72 percent of others' costs. The state pays the rest, which means Kentucky taxpayers put billions of dollars a year into it. It's not the sort of program that needs to run under the radar; if we are paying the freight, we need to know what's in the haul, and it helps to know it at the local level.

That's easier now that the state Cabinet for Health and Family Services, which runs Medicaid in Kentucky, has posted monthly Medicaid enrollment reports on its website.

These county-by-county reports are more useful than the annual reports that the cabinet circulates more more to show the local impact of its programs. The Medicaid figure on those reports is the number of people in the county who received Medicaid benefits at any time during the program's fiscal year (April to March). That number overstates the rolls at any particular time, because many people go on and off Medicaid each month.

For example, the Fiscal 2022 report for Clay County, one of the nation's poorest, shows 15,922 total beneficiaries in the year, but only 12,815 in the month of June. That is still 62.6 percent of the county's estimated population of 20,484.

That said, the annual reports provide much more information about Medicaid than the monthly reports; among other things, they:

• Break down Medicaid enrollment into types of enrollees: traditional, expansion, children in foster care, and "presumptive eligibility," people who have been enrolled during the pandemic without all the usual checks for eligibility, under legislation passed by Congress. Starting April 1, states will have to start running all the usual checks, and many people will no longer be eligible. In Clay County, for example, 2,842 presumptive eligibles were on the rolls in fiscal 2022, or 18% of the total enrollment.
• Give the number of children who were beneficiaries at any time during the year; in Clay County, 4,612 kids were helped by Medicaid in fiscal 2022. 
• Give the top five diagnoses for adults and children on Medicaid, which can vary widely from year to year. In another poor county, Clinton, the top five diagnoses for adults in fiscal 2021 were chronic obstructive pulmonary disease, hypertension, unspecified illness, opioid dependence and diabetes, in that order. In fiscal 2022, they were hypertension, Covid-19, contact with and suspected exposure to Covid, myopia (nearsightedness) and "other fatigue."
• Give the top five procedures performed on beneficiaries and the top five medications prescribed for beneficiaries. In both Clay and Clinton counties in the last two fiscal years, the most-prescribed drug was naloxone, which reverses the effect of a drug overdose.
• Show the number of health-care providers who served residents of the county and the total they were paid. For example, in Clinton County in fiscal 2022, residents were served by 48 providers who were paid $33 million; $14.3 million of that went to local providers.
• Show the number of newborn screenings and other figures on programs for children, including the percentages of foster children who had an official goal of adoption, and the number with other official goals, such as reunification with their birth families.

The annual reports give much information on programs other than Medicaid, such as the Supplemental Nutrition Assistance Program (once known as food stamps), behavioral-health services (including syringe exchanges), other services by local health departments, health-insurance assistance, child-care assistance, child-support enforcement, social services (such as meals, home care and other services to seniors), and funding of Family Resource and Youth Service Centers, which serve public-school students and their families. The reports also list the number of cabinet employees working in each county.

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Critical access hospitals, which turned 25 in 2022, are vital to providing health care in rural areas; Kentucky has 25 of them

By Melissa Patrick
Kentucky Health News

Critical access hospitals celebrated their 25th anniversary in 2022. The designation was created to ensure the financial viability of the nation's small, rural hospitals. Kentucky has 25 of them, and at least one health official says they may be more important now than ever. 

"I could even make the argument, they're more important today than they were 25 years ago just simply because the stress and strain that's been put on the healthcare system in general gets tougher every year," said Hal Clark, vice-president of the Kentucky Hospital Association's solutions and member-services group. 

Barbourville ARH Hospital serves mainly Knox County.

Barbourville ARH Hospital CEO Charles Lovell also pointed to the value of CAHs, noting that during the pandemic they had to turn offices into patient rooms because there were so many patients and larger hospitals couldn't accepts transfers. More recently, he said, they have been near capacity because of respiratory illness.

"We are the lifeline for many of those patients," he said. "I just want people to realize that even though critical-access hospitals are smaller hospitals inside, we're not smaller in the care and the quality of care that we provide." 

The CAH designation came about after the closure of more than 400 hospitals during the 1980s and 1990s. The legislation that created the designation, spearheaded by Montana Sen. Max Baucus, was aimed at reducing the financial vulnerability of rural hospitals and improving quality, while also improving access to health care by protecting essential services for rural communities. 

Two key requirements for a CAH is that it have no more than 25 acute-care inpatient beds and be more than 35 miles from another hospital, with some exceptions. In return, CAHs are reimbursed at 101% of the costs reported to Medicare for inpatient, outpatient, laboratory and therapy services, as well as post-acute care in the hospital's swing beds, which are beds that allow for the care of acute patients as well as those who need skilled, longer-term care.

Lovell also spoke about how important expansion of the Medicaid program has been to the viability of rural hospitals. More than 400,000 Kentuckians gained health insurance coverage through Medicaid after the state expanded the program in 2014 to people who earn up to 138% of the federal poverty level, under the Patient Protection and Affordable Care Act.

"We, as hospitals, are fortunate that Kentucky adopted Medicaid expansion," Lovell said, calling it a "financial windfall" because it led to more of their patients having health insurance. He said 80% of the Barbourville hospital's revenue comes from Medicare and Medicaid. 

Clark, of the hospital association, called CAHs "an absolutely critical piece of the puzzle" when it comes to taking care of rural Kentuckians and said the state would be in a tough position without them. 

"If those hospitals were to close, in an under-served, very rural part of our state, then patients that needed to access health care are going to have to drive very long distances to receive care," he said. "That could mean the difference between life and death for some people. And so it's very important that those services remain viable and remain available to people in rural parts of our state." 

Further, he said, transportation remains a huge barrier to getting care for many Kentuckians in rural areas and CAHs provide much needed services close to home. 

These small hospitals are also important economic engines in their communities, Clark said. Hospitals are often one of the largest employers in rural communities, with some of the best-paying jobs. 

Rural hospitals continue to experience financial, operational and staffing challenges, and whether they have one patient or 25, they must remain fully operational, said Lovell. 

But Lovell said his hospital is not considering converting to the new "rural emergency hospital" program that allows hospitals with 50 or fewer inpatient beds to convert to outpatient-only service.

"As health care evolves, we may have to look at things differently," he said. "But we all want to be around 25 years from now." 

Clark said none of the qualifying rural hospitals in Kentucky are actively pursuing then new option, but  KHA has encouraged them to be aware of the program and to know it is an option going forward.

Emily Baumgaertner of The Washington Post wrote recently about the program, "The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs. But the new opportunity is presenting many institutions with an excruciating choice."

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Risk of Covid-19 increased last week in Ky.; booster vax rate low; exercise can thwart severe cases; dogs can detect the infection

By Melissa Patrick
Kentucky Health News

The federal Covid-19 risk map showed more Kentucky counties at medium and high risk of transmission than last week, and the number of counties at low risk dropped to just over half. 

"Covid-19 does appear to be increasing following the Thanksgiving holiday so it's important that if you haven't gotten your booster that you do that," Gov. Andy Beshear said Thursday at his weekly briefing, held before the latest risk-map was released. 

He said current data shows that fewer than 11 percent of Kentuckians who are eligible to get the updated Covid-19 booster shot have gotten it. 

Centers for Disease Control and Prevention map

The Centers for Disease Control and Prevention's latest risk map shows 17 Kentucky counties at high risk of transmission, a number that has been creeping up since early December when 10 counties were reported to have high risk. Such counties are shown in orange on the map. 

Counties with high risk of transmission last week include the same cluster of counties in Western Kentucky from the last two reports; the other high-risk counties were scattered: Butler, Simpson, Monroe, Harrison, Robertson, Rowan, Johnson and Pike. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality 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.

Medium-risk counties, shown in yellow, increased to 42, up 15 from the week prior, and the number of low-risk counties, shown in green, dropped to 61, down from 78 the week prior. 

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.

Exercise can protection against Covid-19

Besides vaccinations, boosters, social distancing, keeping your hands washed and wearing masks in public places, a study has found another way to protect yourself from severe Covid-19: exercise. 

The study looked at how exercise affected coronavirus outcomes in nearly 200,000 adults in Southern California. It found that people who worked out at least 30 minutes most days were about four times more likely to survive Covid-19 than inactive people, Gretchen Reynolds reports for The Washington Post.

The study, published this month in the American Journal of Preventive Medicine, "found that exercise, in almost any amount, reduced people’s risks for a severe coronavirus infection. Even people who worked out for as little as 11 minutes a week — yes, a week — experienced lower risks of hospitalization or death from Covid than those who moved about less," Reynolds writes.

The data in the study was collected before widespread coronavirus vaccines were available, but Robert Sallis, a senior author of the study, told Reynolds that he thinks the results would be similar among vaccinated people: "It is such a simple, inexpensive way to protect yourself."

Free Covid-19 tests

It's also important to test for Covid-19 if you have symptoms, before and after traveling for the holidays and before visiting indoors with immunocompromised or vulnerable individuals. 

Toward that end, the Biden administration has restarted a program that allows every household in the country to receive four free Covid-19 test kits. These at-home tests can be ordered at CovidTests.gov. This is the third round of free kits the administration has made available. 

People who have difficulty accessing the internet or need additional support placing an order can call 1-800-232-0233 (TTY 1-888-720-7489) to get help in English, Spanish, and more than 150 other languages, 8 a.m. to midnight ET any day. More information is at https://www.covid.gov/tests/faq.

Dogs can detect Covid-19 at mass events

Another study published this month found that dogs trained to detect Covid-19 infection by smell correctly identified individuals with active infections at concerts with a specificity of nearly 100% and a sensitivity of 81.58%.  

The study used eight dogs of various breeds who were trained to detect positive Covid-19 samples. The dogs were presented with sweat samples from 2802 concertgoers at four events in Germany organized for the study. Each participant had been tested for Covid-19 with both a rapid antigen test and the more reliable PCR test, but the researchers, dog handlers and dogs did not know the results. Most of the human participants were vaccinated against Covid-19, but this did not affect the dogs’ ability to detect active infections.

"Our results demonstrate that scent-detection dogs achieved high diagnostic accuracy in a real-life scenario. The vaccination status, previous infection, chronic disease and medication of the participants did not influence the performance of the dogs in detecting the acute infection," the researchers write in BMJ Global Health. "This indicates that dogs provide a fast and reliable screening option for public events in which high-throughput screening is required."

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After Russell County school employees were educated about adverse childhood experiences, suspensions dropped by half

Russell County (Wikipedia map)

Suspensions of elementary-school students in Russell County have dropped by half since 2019, when teachers, staff, counselors, and bus drivers began getting intensive training on the effects of childhood trauma on students' mental and physical health, reports Nadia Ramlagan of Public News Service.

"More kids report feeling safe, cared for, and feel they 'belong' at school," Ramlagan reports, citing the Foundation for a Healthy Kentucky, which provided a grant for the project.

The foundation's senior policy and advocacy officer, Amalia Mendoza, told Ramlagan that rural communities face challenges in reducing behavior problems from adverse childhood experiences.

"We're talking about toxic stress, we're not talking about just any adversity," Mendoza said. "There's really that kind of stress that is ongoing, and that can produce changes even in the brain and in the immune system."

According to the Child and Adolescent Health Measurement Initiative, nearly 40% of American children have had at least one adverse childhood experience (ACE): neglect or abuse, living with someone with a drug, alcohol or serious mental-health problem, the death of a parent, or exposure to violence or discrimination in the home or community.

Tracy Aaron, director of health education for the Lake Cumberland District Health Department, told Ramlagan that adverse childhood experiences have been linked to heart disease, stroke, diabetes, cancer and mental-health problems in the 10-county district. "If you look at the data that backs up ACEs," she said, "we have a very high rate of poverty, we have teen pregnancy. Substance use is an issue."

Russell County School Supt. Michael Ford told Ramlagan that schools can't fix family problems, but can remove barriers that affect academic performance and provide spaces where students see de-escalation, self-care and effective problem-solving techniques, and healthy relationships.

Ford said, "We want our kids to be resilient, right? Number one, we want to prevent anything that we can help prevent. Kids, regardless, are going to have ACEs, but ACEs do not have to hold them back."

He said successful strategies in the district include parent and grandparent training on how to build kids' resilience, increasing support for school counselors, and changing discipline policies.

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Big, real-world study confirms Covid-19 shots provide much more protection than natural immunity, especially against death

Vaccines give significantly more protection than natural immunity against Covid-19, especially against death, according to one of the first large, real-world studies comparing the two forms of immunity.

The study found that to be true of all age groups in protecting against death, hospitalizations and emergency department visits. "The lower death rate of vaccinated individuals was especially impressive for adults ages 60 years or older," said a press release from the Regenstrief Institute at the Indiana University School of Medicine and the Vanderbilt University Medical Center, which did the study.

“The data raises questions about the wisdom of reliance on natural immunity when safe and effective vaccines are available,” the release said.

Vaccinated people had a higher rate of Covid infection than individuals previously infected (6.7% to 2.9%), but the vaccines “protected against severe disease while natural immunity did not confer the same benefit,” said Dr. Shaun Grannis, the study's corresponding author and vice president for data and analysis at the Regenstrief Institute. 

The release said, "The all-cause death and hospital-admission rates for vaccinated individuals were 37 percent lower than the rates for those with natural immunity acquired from previous Covid infection. The rate of ED visits for all causes was 24 percent lower for vaccinated individuals than for the previously infected."

Gannis said, “This large population study of the entire state of Indiana should encourage individuals everywhere to get themselves and their children vaccinated and not rely on natural immunity. As vaccinated individuals were more likely to actually get Covid than those with natural immunity, the lower death rate of vaccine recipients who develop Covid appears to be due to vaccination and not to a tendency for risk-averse behaviors, such as mask-wearing, hand sanitizing and social distancing.”

The study analyzed data on pairs of vaccine recipients and people with prior infections, matched by age, sex, dates of initial exposure to the vaccines or the virus itself, and Covid risk scores as defined by the U.S. Centers for Disease Control and Prevention. The data came from the Indiana Network for Patient Care, one of the nation’s largest health information exchanges, as well as death reports from the State of Indiana, the release said.

The study is important because previous studies didn't look at emergency-department visits, hospitalizations and mortality for non-Covid reasons, said its first author, Regenstrief Institute Research Scientist Wanzhu Tu, Ph.D. “Our work confirms that mRNA vaccines have kept people out of the ED and the hospital as well as lowered the likelihood of death from any cause. And we saw this pattern in every age group.”

The study, SARS-CoV-2 infection, hospitalization and death in vaccinated and infected individuals in Indiana USA, November 2020 - February 2022, is published in the American Journal of Public Health. 

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How to manage your mental health in the holiday season

By Dr. Gopalkumar Rakesh

Assistant professor of psychiatry, University of Kentucky

For many, the holiday season is not always the most wonderful time of year. With work and school deadlines quickly approaching, holiday shopping expenses piling up, and back-to-back large social gatherings, this time of year can eventually take a toll on one’s mental wellness.

According to the National Alliance on Mental Illness, a study showed that 64% of people with mental illness report holidays make their conditions worse. In a separate study conducted by the American Psychological Association, 38% of people surveyed said their stress increased during the holiday season.

Photo by Tommaso79, Getty Images / iStock Plus

Increased stress can cause symptoms of physical illness, depression, loneliness and more. If you or a loved one are experiencing increased stress this year’s holiday season, here are some tips to help make your season a bit jollier.

Manage your time: Remember that your priorities still matter, and procrastination is not your friend. Putting off important projects can cause unwanted stress. Be sure to prepare ahead of time if you have important deadlines approaching to ensure that you do your best. Try making a schedule of when you will work on your projects and do your holiday prep to make sure your schedule is balanced, productive and not rushed.

Set boundaries: Communicate your limits as early as possible to friends and family so that everyone is on the same page. It is okay to say no to social obligations that may be too stressful. Choosing to set boundaries surrounding stressful conversations on topics that may be contentious in a family setting may also be advised.

Take care of yourself: The holiday season is not only about spoiling those you love but making yourself a priority as well. Fight seasonal depression by staying on top of your sleep and exercise schedule. If you can, work near a window throughout the day to get as much sunlight as possible. Even adding bright holiday lighting throughout your work or engaging with mindfulness apps on your smartphone can help boost your mood.

Seek support: Check in with a local support group or friends who understand what you may be going through. Surrounding yourself with people who feel similar can help combat feelings of loneliness.

If you or someone you know needs additional support, reach out to your therapist if you have one, talk to a mental-health professional or contact your primary-care physician.

Additionally, if you or a loved one are experiencing a suicidal crisis or mental distress, call or text 988 to reach the Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline) to access free and confidential support 24/7.

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Rep. Guthrie, in line to head health panel, says priorities include Medicare oversight, Covid-19 origins and price transparency

U.S. Rep. Brett Guthrie, R-2nd District (C-SPAN screenshot)

U.S. Rep. Brett Guthrie of Bowling Green discussed several health issues that Republicans will focus on when they take over the House during an interview with Caitlin Owens of Axios, including price transparency, investigations into the origin of Covid-19 and oversight of the Medicare drug-negotiation provision in the Inflation Reduction Act. 

Guthrie, a Republican who represents the Second District, is in line to lead the health subcommittee of the House Energy and Commerce Committee when the new Congress convenes next month. 

Asked about the evolution of the GOP's health agenda since the days when the party wanted to "repeal and replace" the Affordable Care Act of 2010, Guthrie said there are still things that need to be done with the ACA, noting that the Inflation Reduction Act recently "took $288 billion out of Medicare . . . and put it into subsidies for the Affordable Care Act." 

Actually, $288 billion was not literally removed from Medicare to pay for the ACA subsidies that were increased as part of the Inflation Reduction Act. Instead, the Congressional Budget Office estimated that provisions in the Act to lower prescription-drug costs in Medicare and reduce drug spending by the federal government would reduce the federal budget by $288 billion over 10 years.

Asked about this, Guthrie's office explained in an e-mail that under budget reconciliation rules, new spending cannot be added to the deficit without it being offset. The cost of the enhanced ACA subsidies was only $33 billion, but his office said, "Rep. Guthrie was making the argument, given the score and the reconciliation rules, that these savings from Medicare are being used to offset other parts of the Inflation Reduction Act, including ACA subsidies."

Guthrie's office said he introduced an amendment to the Act to not allow the savings from Medicare to be used to "pay for or offset any program, activity or expenditure that is not with respect to the Medicare program under such title," but the amendment was not considered. 

In the Dec. 7 Axios interview, Guthrie said of the ACA, "It's not sustainable.  . . . Prices keep going up, we subsidize it and it's pricing people out of the marketplace, which still needs to be addressed."

Guthrie said another priority for his subcommittee will be oversight of the implementation of the provisions in the Inflation Reduction Act that authorize Medicare to negotiate prices with drug manufacturers.

He said that the worst thing that can happen in the negotiations is that they will reduce innovation by drug makers, noting that one company has already announced it will not do a third-phase study of a new drug because of concerns about pricing going forward.

"We want more innovation, not less," Guthrie said. "And I'm afraid that's where we're going." 

The CBO estimates that the drug pricing and negotiation provisions in the Act "will have a very modest impact on the number of new drugs coming to market in the U.S. over the next 30 years; 13 fewer out of 1,300 or a reduction of 1%," reports the Kaiser Family Foundation.

Guthrie said Republicans will also focus on price transparency, calling it a bipartisan issue that has not yet been resolved. The Trump administration required hospitals to disclose the rates they privately negotiate with insurers and also provide online, searchable rates for 300 common services. 

"I think we need to make sure that information is out there," Guthrie said. "We need to expose if the price is right, then that's what the price is, but my guess is there seems to be a lot of steps in the supply chain of health care and we're not sure of the value of every step." 

Guthrie also said it will be important to investigate where Covid-19 originated as a way to prepare for future pandemics. "The purpose is to lead to legislation or information that we need to move forward," he said. "One of my biggest concerns as we look at what's moving forward is bringing trust back into our institutions. . . . We need to know that the groups that are supposed to put forth science are putting forth science in the public sphere so the policy makers can make decisions in the public and have confidence." 

As an example, he pointed to White House medical adviser Dr. Anthony Fauci's early dismissal of the idea that the virus came from a lab in China, even though "We now know that it probably did come from there." That is a matter of opinion, and the stated view of most experts is that the virus originated naturally.

Guthrie is co-chair of the Republican Healthy Future Task Force, which has put together a list of proposals that seeks to improve health-care choices for workers and small business owners, promotes innovation and transparency and lowers costs and increases options through competition. 

Inside Health Policy, reporting on its own interview with Guthrie, says that "If tapped as chair, he would focus on medical-product innovation, price transparency and health-agency oversight, including looking into FDA’s use of emergency use authorizations to ascertain lessons for future pandemics and the agency’s response to the infant-formula shortage to improve its handling of ongoing drug-supply issues."

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Two studies, one of seniors and the other of all ages, show Covid bivalent booster shots very effective at preventing severe disease

Katelyn Jetelina, right, interviews the CDC's Dr. Ruth Link-Gelles about boosters.

By Katelyn Jetelina

Your Local Epidemiologist

We got an early holiday present. One of the last puzzle pieces about the fall Covid-19 boosters was released today: data on the effectiveness against severe disease. We have nine lab studies and one real-world study showing the fall boosters provide:

• Greater protection against infection and transmission, by boosting our first line of defense—neutralizing antibodies. (See my previous updates here.)
• Broader protection, or the ability to create antibodies that “see” more virus parts and “attach” more strongly compared to the antibodies we have right now. (See my previous updates on this here.)
• Longer protection against infection and severe disease, even just by a few months. We are still at the mercy of time for this, but have promising data from the Beta bivalent vaccine clinical trials.

Until now, we didn’t know whether they provided additional protection against severe disease and hospitalization. We now have three real world analyses, and things are looking good.

The CDC released studies answering the same question from two different perspectives. The first study , in 22 large hospitals in 18 states, found that among patients 65 and older with no Covid-19 vaccination, effectiveness of the fall booster against hospitalization was 84%; among who had received mRNA vaccines, effectiveness was 73%.

The second study, at nine hospitals in 11 states, looked at emergency room and urgent care visits (a proxy for more severe disease) for patients of all ages. It found that among people with no vaccination, effectiveness of the fall booster against emergency room or urgent-care visits was 56%. Among the vaccinated, effectiveness was less with more recent vaccination (reflecting the fact that vaccine protection wanes over time). If someone got their last mRNA shot two to four months ago, effectiveness was 31%. If the last dose was more than a year ago, effectiveness was 50%.

Dr. Ruth Link-Gelles, program lead of Covid-19 vaccine effectiveness at the CDC, told me, "These vaccines provide pretty substantial additional protection, especially if it's been a long time since you got you last monovalent dose." But we still don't know how long protection will last, so studies will continue.

Bottom line: The fall boosters work. There is now evidence fall boosters broaden protection, help against infection, protect against severe disease, and (we think and hope) provide longer protection. There is one major problem though: more than 150 million people are eligible for a fall booster in the U.S. and have yet to get one.

Link-Gelles blamed that on Covid fatigue and people seeing fewer hospitalizations and deaths from the disease, but she said now is good time to get boosted because of holiday gatherings, especially with grandparents, who are more vulnerable. She said 28 million Americans over 65 have not gotten a booster.

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How to not pick up pounds during the holidays, and how to eat in general: Consume more in the morning, less in the evening

By Michael Crupain, Michael Crozien and Ted Spiker
National Geographic

Heading into the winter holidays, 'tis the time for eating — and plenty of it. But food can affect your body differently throughout the day, so let’s take a closer look at that internal timepiece.

Understanding your biological clock is the key to shifting your body to optimal function. The biological clock is your body’s automated energy conservation system, influencing behavior on a cellular level from sunset to sunset.

Some people live in opposition to their bodies’ natural instincts — and this is an important example of how food plays a role in the rhythm of life. About 15 million workers in the United States have shift jobs; they work nights and sleep during the day. Studies examining the health of these populations find that they have increased rates of both sleep issues and obesity. People who work the night shift tend to gain more weight than people with normal nine-to-five schedules.

Although we don’t completely understand the cause, the main suspect behind the disturbances in the health and metabolism of shift workers is that they are fighting their natural circadian rhythms — and their body’s instinctual notions of when to eat.

Our body clock and our food clock have a natural tension point: We crave food at night, but we function better when we eat earlier. Research has shown that in the absence of normal light and time cues, people are naturally the hungriest around the time that would correspond to 8 p.m. and least hungry at the time that would correspond to 8 a.m.

That basic instinct was an advantage in the early days of human existence, but in modern times it may be hurting us. One of the body’s most important hormones for dealing with food is insulin, which regulates the amount of glucose in the blood.

The body’s secretion of and response to insulin follows a circadian rhythm. Studies suggest that sensitivity to insulin is highest during active phases (when we are awake) and most insulin resistant during their typical sleeping hours. Mealtime has a big effect on what happens to your blood-sugar levels; if you eat the same meal in the morning and at night, your blood sugar will increase more in the evening than in the morning.

Fat cells also appear the most insulin sensitive early in the day, with a peak at noon; they are about 50 percent more sensitive midday than they are at midnight. This means that your body is primed to eat at certain times. In fact, eating at the “wrong” time can throw off everything. One study found that those who ate lunch earlier lost more weight than those who ate later. A related study found that those who ate later burned less energy.

Research has shown that our body’s natural rhythm is to want food later, even though it has a negative effect on our overall health. Why are our body’s food cravings out of sync with our circadian rhythm? During periods when we didn’t know when our next meals would come, the human body may have evolved the need for a food-storage mechanism. In that era, humans didn’t live long enough to experience the harms of late-night eating—and in any case, the body only cared about surviving the next day, not the next decade.

Today, we no longer need that extensive storage ability because food is plentiful. We have to consciously override our ancient instincts and make smart choices about when to eat—and that means more in the morning, less later on.

This excerpt is adapted from What to Eat When: A Strategic Plan to Improve Your Health and Life Through Food, originally published by National Geographic Partners, LLC, on December 31, 2018. Copyright © 2019 Michael F. Roizen and Michael Crupain. Compilation copyright © 2021 National Geographic Partners, LLC. All rights reserved.

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Federal audits reveal widespread overcharges, other errors in Medicare Advantage plans; Humana and United stand out

Illustration by Eric Harkleroad, Kaiser Health News, from federal Medicare data

By Fred Schulte and Holly K. Hacker
Kaiser Health News

Recently released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by Kaiser Health News through a three-year Freedom of Information Act lawsuit, which was settled in late September.

A review of the audits reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

UnitedHealthcare and Louisville-based Humana, the two biggest Advantage insurers, accounted for 26 of the 90 contract audits over the three years.

Eight audits of United plans found overpayments, while seven others found the government had underpaid. Humana's 11 audits with overpayments included plans in Florida and Puerto Rico that CMS had audited twice in three years.

The Florida Humana plan also was the target of an unrelated audit in 2021 by the Department of Health and Human Services inspector general. That audit, which covered billings in 2015, concluded Humana improperly collected nearly $200 million by overstating how sick some patients in its Medicare Advantage plans were. Officials have yet to recoup any of that money, either.

In an email, Humana spokesperson Jahna Lindsay-Jones called the audit findings "preliminary" and noted they were based on a sampling of 2015 claims.

"While we continue to have substantive concerns with how CMS audits are conducted, Humana remains committed to working closely with regulators to improve the Medicare Advantage program in ways that increase seniors' access to high-quality, lower cost care," Lindsay-Jones wrote.

Medicare Advantage is an alternative to original Medicare and is primarily run by major insurance companies. As it has gained popularity among seniors, CMS has fought to keep its audit procedures, and the mounting losses to the government, largely under wraps. That approach has frustrated both the industry, which has blasted the audit process as "fatally flawed" and hopes to torpedo it, and Medicare advocates, who worry some insurers are getting away with ripping off the government.

Insurers can have some claims excluded from the audit by claiming hardship, such as the closure of clinics where the services were rendered. Hardship requests and other documents obtained by KHN in the lawsuit shed light on the secretive audit process.

Reacting to the audit findings, Iowa Sen. Chuck Grassley called for “aggressive oversight” to recoup overcharges. Grassley is the top Republican on the Senate Finance Committee, which oversees health insurance. He said, “CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments.”

How Medicare Advantage works

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify patients' conditions. Only about 5% of Advantage plans are audited each year.

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.

Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over three years.

In many cases, auditors found that the medical credentials of the health-care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.

The rates of billing codes rejected by auditors varied widely across the 90 audits. Seven health plans had fewer than 10% of their codes flagged, but the rate of invalid codes topped 80% at a defunct New York HMO.

One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics.

Other Medicare Advantage health plans said they had no luck retrieving medical records from doctors who had moved, retired, or died — and in some cases been arrested or lost their licenses for misconduct.

CMS found most excuses wanting, telling health plans that it granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20% of them.

Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”

Protecting Taxpayers

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans in the 2011-13 audits at $650 million, but how much it will eventually claw back remains unclear.

Payment errors continue to be a drain on the program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses in 2022 at $11.4 billion.

“This isn’t a partisan issue,” said Sen. Sherrod Brown (D-Ohio). “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.”

Leslie Gordon, acting director of health care for the Government Accountability Office, the auditing arm of Congress, said CMS needs to speed up the audit and appeals process to get quicker results.

“That is money that should be recovered,” Gordon told Kaiser Health News.

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should.

America's Health Insurance Plans, an insurance industry lobby, criticized Kaiser’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.”

Jeff De Los Reyes, a senior vice president at the GHG Advisors health-care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “Coding is never 100% perfect and there will be errors despite the best of intentions.”

Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with policy pnalysis and polling, KHN is one of the three major operating programs of the Kaiser Family Foundation, an endowed nonprofit organization providing information on health issues to the nation.

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58% of Kentucky adults say the pandemic is over for them, and resistance among the unvaccinated to getting a shot is increasing

By Melissa Patrick
Kentucky Health News

Four in seven Kentucky adults (57%) think the pandemic is over in the state and more than 80% say concerns about Covid-19 will not keep them from attending or hosting gatherings during the holiday season, according to a Foundation for a Healthy Kentucky poll taken from Oct. 29 to Dec. 4. 

"Kentuckians are, I think as a general matter, determined that this pandemic is over," Ben Chandler, president and CEO of the foundation, said Tuesday. "They're going to behave like it for the most part during the holidays."

Chandler that's appropriate, if people are up-to-date on their Covid-19 and flu vaccinations, keeping their hands washed and staying home when they are sick. But the poll found that resistance among unvaccinated Kentuckians to getting vaccinated to protect them from the disease continues to increase.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll found that 59% of Kentucky adults said it is "not likely at all" that Covid-19 will prevent them from attending or hosting a small gathering with friends and family this holiday season and 22% said it is "not too likely" that Covid-19 will impact this decision. Only 4.4% said it is "very likely" and 12.5% said it is "somewhat likely" that Covid-19 will affect their decision to gather with others over the holidays. 

Being vaccinated didn't seem to matter when making the decision to attend or host a small holiday gathering, as 73% of those who were vaccinated with at least one booster, 86% of those who were  vaccinated with no boosters and 91% of those who were not vaccinated said they were either not likely at all or not too likely to let Covid-19 impact their decision to attend or host a small holiday gathering

Further, the poll found that more men (69%) than women (50.2%) said they were not likely at all to let Covid-19 prevent them attending or hosting a small holiday gathering.

Hanukkah begins Sunday, Dec. 18; Christmas is Sunday, Dec. 25, and Kwanzaa starts Dec. 26.

The poll was the latest edition of the Vaccines in Kentucky Poll, which the foundation has sponsored four times since February 2021.When asked if they thought the pandemic was over in Kentucky, 41.5% of the respondents said it was. That was an increase over the summer, when 31.7% said it was. 

The share of Kentucky adults who said the pandemic was not over decreased to 56.6% in the latest poll, down from 65.4% in the summer. 

And when asked if the pandemic was over as it pertains to their own lives, 58.1% of the respondents said it was, up from 53.3% in the summer poll. This rate was highest among Kentucky adults who were not vaccinated (80.1%), followed by those vaccinated but not boosted ( 61%) and those vaccinated with at least one booster (42.2%).  

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll also found that nearly three-quarters of vaccinated Kentuckians (73%) were either "very likely" or "somewhat likely" to get an annual Covid-19 booster if that were recommended like annual flu shots are.

The groups of vaccinated Kentuckians most resistant to getting an annual Covid-19 booster in the future were those who live in suburban counties (37%) and those between the ages of 30 and 45 (39.5%), either saying they were either "not too likely" or "not likely at all" to receive an annual booster. 

In rural and urban counties, about 75% of Kentucky adults in these areas said they would be very or somewhat likely to get a booster if recommended.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

Since the first Vaccines in Kentucky Poll was taken in February 2021, an increasing share of Kentucky adults have said that getting vaccinated is a personal choice, rather than part of everyone's responsibility to protect the health of others. That view rose to 65% in the latest poll, marginally more than the 63% found this summer. In February 2021, shortly after vaccines became available, polling showed a nearly even split on the question. (Each number in the statewide sample has an error margin of plus or minus 3.4 percentage points.)

The belief that vaccination is a personal choice is greatest among rural Kentuckians, with 72% of them saying they agree with that statement and 27% of them saying getting vaccinated is everyone's responsibility to protect the health of others. In suburbs, the numbers were 66% and 32%, respectively; in cities, they were 57.5% and 41.8%. 

The latest poll also found that the number of unvaccinated people in Kentucky who said they will "definitely not get the vaccine" has increased to 75.2% in the latest poll, up from 63.5% in the summer. 

The poll, which was funded by the foundation, was conducted by the University of Cincinnati's Institute for Policy Research. It surveyed a random sample of 855 Kentucky adults via landline and cell phones.

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New cases of the flu outnumber new cases of the coronavirus in Kentucky, but deaths from Covid-19 went back up last week

Centers for Disease Control and Prevention map, adapted by Kentucky Health News

By Melissa Patrick and Al Cross
Kentucky Health News

Newly confirmed cases of influenza are outpacing new cases of the coronavirus in Kentucky, and the state is among the national leaders in new flu cases. Meanwhile, though, deaths from Covid-19 are going up.

The Centers for Disease Control and Prevention has Kentucky, 10 other states and the District of Columbia in the “very high” category of flu-like illnesses. That's based on reports for the week ending Dec. 3, when Kentucky had at least 7,192 new cases. The previous figure was 6,398. The CDC says "at least" because unlike Covid-19, flu cases do not have to be reported to health authorities.

In the week ended Sunday, Dec. 11, the state Department for Public Health reported 5,214 new coronavirus cases, an average of nearly 745 per day. That's 9% lower than the week before, when the state was averaging 821 new cases per day. Of last week's cases, 14.5% were in people 18 and younger.

The state attributed 51 more deaths to Covid-19, up from 28 the week before and higher than a month of weekly reports before that, which showed an average of 45 deaths per week. Kentucky's pandemic death toll totals 17,580. 

The flu has killed at least 29 Kentuckians this season. The Lexington-Fayette County Health Department reported Dec. 7 that six were in its jurisdiction. “The flu is hitting hard in Lexington,” spokesman Kevin Hall said in an email. “There are already more total lab-reported cases in the first 9 weeks this season than in the previous three years combined.”

The state's weekly Covid-19 report shows that the share of Kentuckians testing positive for the coronavirus was 8.63%, up just a bit from 8.14% the week before. The figures do not include at-home tests. 

All said, it appears that when it comes to cases and positivity rates, Covid-19 Kentucky remains on a the rough plateau seen for about three months.. 

Covid-19 hospitalizations barely increased last week, after taking a big jump in the last one, and the number of severely ill patients went down. Hospitals reported 388 patients with Covid-19 Monday morning, an increase of five over the prior Monday; 45 were were in intensive care, down 14; and 19 were in need of mechanical ventilation, down 10. 

The weekly new-case incidence rate was 15.82 cases per 100,000 residents, down from 16.29 the week before. The top 10 counties were Bath, 38.9 cases per 100,000;  Powell, 33.5; Washington, 33.1; Leslie, 30.4; Calloway, 30; Hart, 29.3; Simpson, 27.7; Metcalfe, 27; Montgomery, 26.9; and Union, 26.8.

The New York Times ranks Kentucky's coronavirus incidence rate 20th among states, even with a 16% drop in cases in the last two weeks. 

Nationwide, the Times reports, "Conditions are worsening across the country, with reported cases and hospitalizations up more than 25 percent in the past two weeks and test positivity rates rising quickly."

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Number of Ky. counties with high and medium Covid-19 risk tick up a bit; Beshear says it's likely due to 'post-Thanksgiving bump'

CDC map, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

The number of Kentucky counties with high and medium risk of Covid-19 transmission on the latest Centers for Disease Control and Prevention map released Thursday were about the same as the week before, when they were higher than they had been for a while. 

At his weekly news conference Thursday, which was held before the map was released, Gov. Andy Beshear said recent increases in counties with high and medium transmission risk in the previous map,, and the increase in cases on Monday's weekly state report, were likely due to a "post-Thanksgiving bump." He said the pandemic in Kentucky still appears to be on a general plateau, but he expects cases will tick up for a few weeks before they come back down. 

"Here's the good news, though: It is nowhere near what we saw after each of these holidays the last couple of years," Beshear said. "This means Covid has fundamentally changed and our highs are going to be a lot lower and that's a very good thing for all of us." 

The latest risk map, which looks at both cases and hospital data to determine risk of transmissions, shows 12 Kentucky counties at high risk, up from 10 the week before. High-risk counties, shown in orange, were in Western Kentucky except for Bourbon, Nicholas and Pike counties. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality 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.

Medium-risk counties, shown in yellow, numbered 44 this week, down from 48 on the previous map. These counties are found in several pockets across the state, mainly in the east and south. Again, barely a majority of the state's 120 counties (64) have a low risk of Covid-19 transmission, shown in green. 

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. It shows 13 Kentucky counties with a moderate level 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 officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures.

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Epidemiologist says the dreaded triple-demic is here, with RSV, flu and Covid-19 cases all rising together

Centers for Disease Control and Prevention map

With national rates of influenza, Covid-19 and respiratory syncytial virus rising together, the "dreaded and much anticipated triple-demic is finally here," epidemiologist Katelyn Jetelina writes in her newsletter, Your Local Epidemiologist. 

RSV is 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.

The weekly Centers for Disease Control and Prevention influenza-like illness (ILI) surveillance, which includes a tally of patients that go to the doctor with a fever and a cough and/or a sore throat is a general indication of the climate of respiratory health in the United States. The report does not include laboratory-confirmed flu cases. 

The ILI map for the week ending Nov. 26 shows that every state but four have a high or a very high ILI activity level. The CDC puts Kentucky's ILI activity level among the very highest. 

Jetelina writes of the national map, "This level is truly unprecedented; we’ve never seen such high levels of ILI activity at this time of year."

Hospitalizations for respiratory illness are also on the rise. CDC Director Rochelle Walensky said Monday, “Hospitalizations are the highest now than they have been in the past decade.” 

In Kentucky, Covid-19 hospitalizations increased for the second week in a row, taking a big jump in this week's Covid-19 report. Hospitals reported 383 Covid-19 patients Monday morning, an increase of 102 over the prior Monday. That same report showed that nearly 80% of the state's inpatient beds and 81% of its intensive-care beds were occupied. 

Jetelina points out that while ILI surveillance offers an overall view of respiratory illness in the U.S, surveillance for specific diseases also exist, but is imperfect. 

RSV: CDC data shows that RSV continues to rise, although we may be seeing the first signs of peaking on a national level, Jetelina reports. She adds that this is expected given that the positivity rate for RSV tests have already clearly peaked. 

Flu: "Flu cases are increasing and increasing fast," Jetelina writes. She notes that flu hospitalizations are lagged, but increasing. "We expect hospitalizations to continue to rise in weeks to come," she writes. 

Kentucky's latest flu report shows that flu activity in Kentucky continues to rise. In the week ending Nov. 26, the state confirmed 6,378 cases of the flu, up from 3,470 the prior week. So far, the total number of confirmed cases during this flu season is 15,909. 

As Inside Medicine reported, for the first time during the pandemic, flu hospitalizations overtook Covid-19 hospitalizations last week. "This may be a one-off occurrence since Covid-19 hospitalizations are increasing now, too, but it is noteworthy," she writes. 

Jetelina adds that epidemiologist are hopeful that the U.S. flu season will follow what has happened in the Southern Hemisphere (Australia specifically) where there has been a high number of flu cases but a moderate level of hospitalizations. 

Covid-19: "Covid-19 is on the rise across the globe due to the combination of seasonal changes, behaviors changes, and the variant soup. In the U.S., all signs point to the beginning of a wave. For example, SARS-CoV-2 in wastewater is rapidly increasing across all regions," she writes. 

In Kentucky, the state Department for Public Health reported 5,751 new coronavirus cases last week, or an average of 821 per day. That's a nearly 49% jump over the week before, when the state reported 3,866 new cases. But that number that was 43% lower than the week before, indicating that Kentucky continues to be on a rough plateau. 

"One major concern is the rapid rise in hospitalizations among older adults, which has exponentially increased 28% in the past two weeks," Jetelina writes. "This is partly (or wholly) due to abysmal vaccination rates—only 1 in 3 adults over the age of 65+ have their fall Covid-19 booster. A public health failure. Without a recent booster, many people are technically vaccinated but not protected." 

Bottom line, she concludes, "This viral season is like no other. . . .  I’m especially concerned for hospital systems, kids under 5, and adults over the age of 65, as they are at highest risk." 

She adds, "There’s a lot we can do: mask, test before seeing loved ones, get that airflow moving, stay home when you’re sick. The least you can do for a healthy season is get a flu and fall Covid-19 booster. If you haven’t gotten one yet, it’s never too late." 

Jetelina is a California epidemiologist and biostatistician who says she writes the newsletter on Substack as a way to translate public-health science for everyday use, helping people to make evidence-based decisions. She is also a consultant to a number of organizations, including the CDC.

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