Ky. Covid-19 numbers continue to improve; study says even mild cases of the disease can be hard on the cardiovascular system

By Melissa Patrick

Kentucky Health News

State and federal measurements of Covid-19 in Kentucky continue to improve each week, but Kentuckians are still dying from the virus and new research suggests that even mild cases of the disease can have long-term effects on cardiovascular health. 

The latest weekly report from the state Department for Public Health showed there were 1,717 new cases of the coronavirus in Kentucky last week, or 245 per day. That's a 24% drop from the previous week's 2,264 cases. 

The state's new case-rate dropped to 3.83 cases per 100,000 residents, down a bit from 3.93 the prior week. The top 10 counties were Breathitt, 24.88 cases per 100,000 residents; Clinton, 12.58; Wayne, 10.54; Green, 10.45; Knott, 9.65; Edmonson, 9.41; Shelby, 9.03; Webster, 8.83; Carter, 7.46; and Grant, 7.41.  

The Centers for Disease Control and Prevention risk map shows a small cluster of  three Kentucky counties with a medium risk of Covid-19 transmission, Bracken, Mason and Fleming. The medium risk counties are shown in yellow. The rest of the state has a low risk of Covid-19 transmission, shown in green. 

Centers for Disease Control and Prevention map; click on it to enlarge.

The CDC also has a community-level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 25 counties with a low level of transmission and 67 with a medium level; the rest are either substantial or high, withe the biggest cluster in the Bowling Green area. The state says residents should take their guidance for prevention from the other map.

Last week, the state attributed 57 more deaths to Covid-19, up from 51 in the previous report, bringing the state's death toll to 18,512. 

Mild cases of Covid-19 can hurt your heart 

A first-of-its-kind study that compared artery stiffness in participants pre- and post-infection found that  "even mild cases of Covid-19 can have long-term detrimental effects on cardiovascular health, says a University of Portsmouth news release.

“Given the number of people infected with Covid-19 worldwide, the fact that infection can have harmful effects on cardiovascular health in young people who had a mild form of the disease warrants close monitoring," Professor Ana Jeroncic from the University of Split in Croatia, who led the study, said in the release. “The question remains as to whether this harmful effect is irreversible or permanent, and if not, for how long it lasts.”

The release notes that the study, published in the Journal of Clinical Medicine, was the first to compare pre and post Covid-infection levels of arterial stiffness, a marker associated with aging and function of arteries. Participants were monitored between October 2019 and April 2022 and most were less than 40 years old and healthy. 

The international team of scientists used baseline measurements from a group of participants involved in a separate study that began pre-pandemic that was also investigating arterial stiffness. They found that "age and time from Covid-19 infection is associated with increased ageing of the arteries, which "could lead to cardiovascular disease development." 

“We were surprised to observe such a decline in vascular health, which deteriorated even further with time since Covid-19 infection. Usually, you’d expect inflammation to decrease with time after infection, and for all the physiological functions to go back to normal or a healthy level," stidy co-author Dr. Maria Perissiou of the University of Portsmouth’s School of Sport, Health & Exercise Science, said in the release.

She added, “We can only speculate on what causes this phenomenon without further investigation, but emerging evidence suggests that it stems from Covid-19 triggering the auto-immune process that leads to vasculature deterioration.”

The paper concludes that these results have important implications for understanding the long-term cardiovascular consequences of Covid-19 and may guide prevention and management strategies for associated vascular disease. It also recommends further research is needed to strengthen our understanding of causes and contributing factors.

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988 suicide-and-crisis lifeline is free and available to anyone in crisis; calls have increased 23% since launch nine months ago

By Melissa Patrick

Kentucky Health News

Kentucky calls to 988, the short, easy-to-remember crisis hotline for mental health, have increased by 23% since it rolled out nine months ago, and there have been 15% fewer abandoned calls, according to Gov. Andy Beshear.

"More people are calling and more people are staying on and talking to someone that can help," Beshear said at his weekly news conference Thursday. "This means Kentuckians facing a risk of suicide, mental-health distress or an addiction crisis are getting connected with compassionate trained counselors more often and faster than ever before. "

988 is confidential and accepts calls, texts, and chats from anyone who needs support for a suicidal, mental-health and/or substance-use crisis.

It is available 24 hours a day, every day and is free of charge. It is available to people of all ages in crisis, and to family members and loved ones seeking guidance. 

"Our first mission is to be here," says Kentucky's 988 website. "So often, the lifeline is about listening and providing an understanding voice. In fact, 95% of lifeline calls are resolved over the phone. But when that’s not enough, we’ll ensure the warmest possible handoff of 988 callers within Kentucky’s crisis service system." 

Most of Kentucky's 988 calls go to one of the state's 13 regional mental-health agencies; callers are connected to the center that is closest to them. 

According to state data from the federal Substance Abuse and Mental Health Services Administration, Kentucky's 988 call centers got 2,888 calls in March and 78% of them were answered in-state. 

SAMHSA says Kentucky calls are answered, on average, in 25 seconds, The national average is 35 seconds and the average talk time is just over 13 minutes.

"That shows that 988 is working and has been a great improvement," said Beshear. "I want to thank all of our partners and mental health advocates across the state and beyond who have worked so hard to make this possible. This administration will always support Kentuckians as they seek health care. We believe that mental health is just as important as physical health, and this is helping us to be able to intervene and ensure that we don't lose people."

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UK medical school and recently added regional campuses will graduate largest class ever, with 42% staying in Ky. for residency

Students in this year's graduating class of the University of Kentucky College of Medicine at Lexington celebrated Match Day in March, when they learned their residency locations. (UK photo by Mark Mahan)

By Allison Perry
University of Kentucky

In 2013, the Commonwealth of Kentucky Health Care Workforce Capacity Report announced a grim statistic: by 2025, Kentucky would be facing an estimated shortage of 960 primary-care physicians, the third-greatest shortfall in the U.S.

The physician shortage is not limited to primary care. The greatest physician shortages in the state include surgical subspecialties, psychiatry, and pediatric primary and specialty care. Rural areas have long had physician shortages, and 61 percent of the greatest physician needs in Kentucky are in rural areas.

“The physician shortage in Kentucky is severe,” said Dr. Charles “Chipper” Griffith III,  acting dean of the University of Kentucky College of Medicine. “There are counties without a single physician, and even in parts of Lexington and Louisville, there are areas that are underserved.”

In the past two decades, the UK College of Medicine has gradually increased enrollment, boosting class size from 100 per year in the early 2000s to 136 graduating physicians by the year 2013.

With class sizes at maximum limits due to classroom constrictions and clinical capacity, UK was forced to turn away several hundred qualified Kentucky applicants to medical school every year, but the College of Medicine and UK HealthCare have worked with other Kentucky clinical partners and other state universities to create opportunities for more Kentucky medical students through regional medical campuses.

The goal is to increase the number of physicians who will stay in Kentucky to practice medicine, expresed as “training Kentuckians in Kentucky to practice in Kentucky,” 

This year, across all four sites of the UK College of Medicine – Lexington, Morehead, Bowling Green, and Northern Kentucky – a record-setting class of 190 medical students are set to graduate and begin practicing medicine.

All combined, these campuses will be able to graduate up to 201 new physicians each year, with a total enrollment of up to 804.

A banner Match Day for Kentucky

Match Day is a longstanding medical-school tradition, a nationwide event where medical students learn where they have matched for their residencies following graduation. The national initial match rate for medical students is roughly 92%, and UK’s rate has historically been higher. This year’s rate, with the largest-ever class of graduating medical students, is 97%. 

But even more important is the match rate of students remaining in Kentucky, Griffith says. Historically, 25 to 30% of UK medical students matched to a residency in Kentucky. That number began growing in 2019, and this year, 42% of UK graduates will be staying in state to begin practicing medicine as a resident. Since 2017, UK has more than doubled the number of new physicians remaining in the state.

With UK’s largest graduating class matching in Kentucky at the school’s highest rate, this bodes well for reducing the physician gap.

“The biggest factor for a physician practicing in Kentucky is both going to medical school and doing a residency in Kentucky,” Griffith said. “Nearly nine of 10 physicians who do both will remain in state to practice when residency is finished.”

With this in mind, UK has placed more emphasis on enrolling in-state students – in recent decades, roughly 70-75% of medical students were from Kentucky, and the goal now is for 85% of each medical class to be a Kentuckian or have a tie to the state.

The Rural Physician Leadership Program

UK's regional approach began with the Rural Physician Leadership Program, developed with Morehead State University and the Morehead hospital, St. Claire HealthCare. The program was developed to train students who are interested in practicing rural medicine after graduating, and the program has capacity for up to 12 students per year.

RPLP students complete their first two years of education on UK’s main campus in Lexington and spend years three and four in Morehead, rotating through St. Claire and other rural clinical sites in the area.

The program began in 2009. With this year’s class, the RPLP will have graduated 110 physicians well-versed in rural medicine, with their top three residency choices being areas of primary care.

Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

“The premise behind this program works,” said Dr. Rebecca Todd, associate dean for the RPLP and an obstetrician-gynecologist at the UK HealthCare Morehead Women’s Health Clinic at St. Claire. “It’s hard to transplant someone who is used to – and who loves – an urban area into a rural area. But if you take students from rural communities and train them to be physicians, they want to go back and practice in those rural communities.”

Having the opportunity to live and train in a smaller community allows RPLP students to have more one-on-one time with the physicians they’re learning from, almost like an apprenticeship, Todd says. Students get the advantage of closer mentorship coupled with UK’s rigorous curriculum to prepare them for their careers in medicine.

“When you work with regional campuses, you get both the resources from the larger institution, like UK, but you also have that smaller, close-knit feel,” Todd said. “I think this program really brings out the best in all medical training.”

The UK College of Medicine-Bowling Green campus

In 2018, UK took another huge step in growing its class size by partnering with Western Kentucky University and Med Center Health of Bowling Green, which operates six hospitals and more than 30 clinics in Southern Kentucky. Students complete their classwork and clinical experience in Bowling Green, primarily at The Medical Center at Bowling Green, the system's main hospital.

“We’re meeting the mission,” said Dr. Todd Cheever, a UK associate professor of psychiatry and the associate dean of the Bowling Green campus. “Having students from this region, where they can train close to their families and support systems, is very important.”

Adding this regional campus has enabled UK to train up to 30 more future doctors each year. This year, the Bowling Green campus will graduate its second class, and seven graduates will stay in Bowling Green for residency.

Nearly half of the Bowling Green campus’s two graduating classes matched into primary-care residencies, and 27 matched into Kentucky health systems.

The UK College of Medicine-Northern Kentucky campus

UK’s most recent regional campus, a partnership with Northern Kentucky University and St. Elizabeth Healthcare, will graduate its first class next month.

This campus has an annual capacity of 35 students, who complete coursework and clinical experience in Northern Kentucky. More than 90% of the students are from Kentucky or nearby counties in southwestern Ohio.

Seven of this year’s inaugural class of 30 graduates will remain in Kentucky for residency, while eight will be working at health-care facilities just across the river in Ohio. Five graduates from across all UK College of Medicine sites will go into residency at St. Elizabeth Healthcare.

Looking toward future growth

Griffith offers some simple math to demonstrate the importance of graduating new doctors: If UK graduates 65 more doctors a year than in the recent past, history shows that roughly half – around 33 – will eventually practice in Kentucky. And if the average physician takes care of roughly 5,000 patients in their lifetime, that could be an additional 165,000 patients in Kentucky each year that now have access to a physician compared to past years, he says.

The regional campuses have room for growth, and UK's Lexington medical campus is growing, too. A Health Education Building now being designed, combined with expansion of UK HealthCare’s clinical services, means that the College of Medicine could add 50 to 65 new students per class in Lexington. By the end of the decade, UK could be graduating nearly 280 new doctors each year – more than double the number who graduated in 2021.

Growing class size also means the need for more teachers, but the response from faculty at the regional campuses, has been overwhelmingly positive. The presence of a medical school has helped Med Center Health and St. Elizabeth Healthcare recruit new physicians, and alumni from UK have been particularly energized and engaged.

“A lot of these physicians didn’t plan on being teaching physicians, but they’ve found that it’s invigorating,” Griffith said. “They really enjoy it, and they’re ready to have more students.”

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First round of state grants from settlements with opioid makers and distributors, more than $8 million, go to 24 organizations

Operation UNITE was one of 24 organizations to get a grant from the first round of opioid settlement money. It got $1 million to be used for prevention. (Photos by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

Attorney General Daniel Cameron announced the first 24 organizations to receive over $8 million in grant funding from the state Opioid Abatement Advisory Commission on Thursday, with 14 of the grants going toward treatment and recovery and 10 for prevention of opioid abuse. 

Attorney General Daniel Cameron makes the announcement.

"The opioid crisis lingers and won't be defeated merely with these dollars," Cameron said at a news conference to announce the awards. "But for the first time in a long time, meaningful relief is here. For the first time in a long time, we have something to rally around, we have a reason for hope." 

So far, Kentucky is in line to get nearly $900 million in settlements with drug makers, distributors and big retailers. Cameron has implied he should get sole credit, at odds with the account of Gov. Andy Beshear, who preceded him as attorney general and whose job he wants. 

Under state law, half of opioid-settlement money is allocated annually by the commission, which is housed in the attorney general's office, and the other half is allocated by cities and counties, among themselves. Cameron said he has worked closely with local governments and the legislature to manage these funds responsibly because "Not a dime can be wasted; too much is at stake." 

The money is required to be used for reimbursement of prior expenses and the funding of new programs related to the prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorders or mental-health issues.

Bryan Hubbard, executive director and chairman of the commission, praised the ongoing commitment of commission members, noting that since being appointed in June 2022, they have had 11 town-hall meetings across the state, 10 business meetings and numerous subcommittee meetings. 

Asked what was gleaned from the town halls, Hubbard said thousands of people attended them and that they inevitably became a "collective, cathartic exercise in communal grief" that revealed common needs across the state, including child-centered prevention programs and recovery services that include housing, transportation services, life-skill training, educational opportunities and formalized vocational training. 

"The organizations that are here . . . have all been resourced to meet those acute needs based on the collected feedback that we receive from thousands," Hubbard said. 

He said the commission hopes to make its next grant announcements sometime in "early to mid-fall" after considering about 65 applications that are seeking $130 million, with only $30 million available. 

Commission Chair and Executive Director Bryan Hubbard

Hubbard said they have 200 applications in the pipeline and that the commission is working to provide grant makers who can offer individualized assistance to organizations that are not used to writing grants "to ensure good, full consideration of our grassroots organizations." 

"We will always remember the thousands of lives that paid for the settlement from which these funds come, for it is blood money," said Hubbard. " You are here because you are the front line foot soldiers who will get in the streets and get in the hollers and bring Kentucky some unified victory." 

Cameron said, "I'm proud to say that because of this office's action, with a lot of you all that are here today, Kentucky stands to receive nearly $900 million in settlement from funds from pharmacies, distributors, wholesalers and manufacturers of opioids. This is Kentucky's share of what is a historic settlement, the second largest such agreement in American history."

Cameron claims sole credit; Beshear says he's shocked

Last week on WKYT-TV's Kentucky Newsmakers, Cameron talked about Beshear filing a lot of lawsuits, but bringing no settlement money to the state. Asked about that Thursday, Cameron said: "We wanted to quit talking about the epidemic and bring meaningful dollars into the state. And we've been able to do that. We're in the process of bringing nearly $900 million into the state. Andy Beshear, when he was attorney general, didn't bring any money into the state. So this has been about not just talking, again, but taking action so that we can hopefully start to have meaningful change in Kentucky."

Beshear was attorney general four years, and such suits usually take many years to litigate. Cameron said, "The fortunate thing is that the settlements that we entered into were separate and apart from the litigation that he was involved in here in Kentucky. And so we had to make a decision about, you know, whether we want to continue to talk as he did for four years in this office, or do we want to bring money into the state and we chose to bring money into the state." 

Asked at his weekly news conference about Cameron's comments, Beshear said, "I'm a little shocked that the attorney general would say I haven't brought any dollars in in opioid settlements. I filed more lawsuits against opioid manufacturers and distributors than any other attorney general in the country. I think he filed one. Every single lawsuit he's settling right now, I not only filed, but I argued personally in court showing up when companies were trying to blame us, for the millions of pills that they sent, hundreds of thousands into really smart communities.

"Listen, as an attorney, you're always supposed to share credit with other lawyers on the suit on a lawsuit or especially the ones who filed it. And if you'll remember, I settled. Actually, Attorney General [Jack] Conway settled the first opioid lawsuit on his way out of office, I was able to award those funds, but we gave credit all the way back to Greg Stumbo, who filed that [suit]. So certainly, first, as attorney general, we did bring in funds to help treatment. Look at Hope in the Mountains in Prestonsburg; it was going to close down without those funds that we provided. Now, they're Medicaid eligible.

"But, I know I filed those lawsuits. I know I did it so that we could have our best shot of getting out of this epidemic. This is blood money that needs to be spent the right way to get people better." 

The list of grants mentioned specific uses in some cases but not in most. Asked for details, Krista Buckell, communications director for the attorney general's office, merely parroted the law: "Each awardee will be pursuing one or more aspects of prevention or treatment and recovery for individuals and communities that have been impacted by the opioid epidemic across the commonwealth."

By far the largest grants were $1 million each to Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) of London, for prevention, and Volunteers of America Mid-States of Louisville, for treatment and recovery. The Louisville-based organization says it "operates nearly 50 distinct human service programs in Kentucky, Tennessee, West Virginia and Clark and Floyd counties in Indiana." 

The other 13 grants for treatment and recovery are going to:

• Shepherd's House of Lexington, a long-term residential recovery program, $141,450. 
• Appalachian Restoration Project, a residential rehabilitation facility in Barbourville, $250,000. 
• Chrysalis House of Lexington, Kentucky’s oldest and largest residential treatment program that specializes in treating pregnant and parenting women, $250,000. 
• Isaiah House, an addiction treatment center with locations across the state, will get $250,000 to support a "comprehensive, dual diagnosis program to help Kentuckians achieve a lifetime of recovery," the list says.
• Lake Cumberland District Health Department, which serves 10 counties, $250,000. 
• Mountain Comprehensive Care Center of Prestonsburg, $250,000.
• Mountain Comprehensive Health Corp., Whitesburg, $250,000.
• Seven Counties Services, a Louisville-based community mental-health center, $250,000.
• Young People in Recovery of Louisville, which serves youth and young adults recovering from substance use disorder, $308,232. 
• Family Scholar House in Louisville, which helps disadvantaged single parents and children reach their educational and career goals, $316,500.
•  Lake Cumberland Community Action Agency will get $375,268 for "comprehensive programs that help low-income Kentuckians achieve greater economic self-sufficiency."
• Appalachian Research and Defense Fund of Kentucky, offering free civil legal help to low-income people in 37 counties, $250,000. 
• Revive Ministries of Nicholasville will get $500,000 to support its faith-based addiction recovery program in Central Kentucky.

The other nine prevention-service grant recipients are: 

• Kentucky Alliance of Boys & Girls Clubs, $500,000. 
• Kentucky Harm Reduction Coalition of Louisville, $500,000.
• Legal Aid of the Bluegrass, $250,000. It provides legal assistance to vulnerable Kentuckians. 
• Legal Aid Society of Louisville, $250,000 to provide free civil legal help concerning opioid-specific matters to people with incomes at or below federal poverty levels. 
• Cumberland Trace Legal Services, dba Kentucky Legal Aid, Bowling Green, $250,000. It provides free legal counsel to those struggling with addiction.
• YMCA of Greater Louisville, $250,000. 
• Prevent Child Abuse Kentucky, Lexington, $243,050. 
• Taylor County School District, Campbellsville, $100,000. 
• Scott County Sheriff, Georgetown, $92,354.13.

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UK study finds children who were exposed to opioids before birth are more likely to develop chronic diseases when they grow up

By Lindsay Travis
University of Kentucky

What happens to the cardiovascular health of babies exposed to opioids in the womb?

A new study at the University of Kentucky suggests that children born to mothers who use opioids during pregnancy may be more likely to develop chronic diseases as adults, including cardiovascular and metabolic diseases. 

Opioid abuse is a key public-health challenge in Kentucky and the U.S., which saw over half a million opioid-related overdose deaths in 2022 alone. The use and misuse of opioids during pregnancy have grown rapidly over the past decade. On average, about one baby born every 15 minutes in the U.S. has an array of symptoms stemming from opioid use during pregnancy, called neonatal opioid withdrawal syndrome.

NOWS symptoms are usually treatable in babies, but scientists have known little about the potential long-term health impacts of in utero opioid exposure once these children grow up.

Analia Loria, Ph.D.

“It is challenging to predict the long-term impact on the cardiovascular health of children from women with opioid misuse and opioid overdoses due to the lack of follow-ups after discharge,” said Analia Loria, Ph.D., senior study author and an associate professor in the Department of Pharmacology and Nutritional Sciences in the University of Kentucky College of Medicine. “However, our studies provide insights regarding how opioids could affect the programming of the mechanisms regulating cardiovascular function and increase the cardiovascular risk.”

The researchers developed a rat model that mimics the use of drugs during pregnancy and studied what happens to the offspring from birth until adulthood. They found that babies of mothers who used drugs while pregnant were shorter at birth and weighed less during the breastfeeding stage. When they started eating independently, they gained weight quickly and caught up to their non-exposed peers, a pattern that has been found to increase the risk of cardiovascular and metabolic disease.

“Overall, we found that the systems that control blood pressure and how sugar and lipids are processed in our bodies are altered in drug-exposed babies,” said Nermin Ahmed, a registered dietitian and UK doctoral candidate in pharmacology and nutritional sciences. “This could mean that adults who were exposed to drugs in the womb are more likely to develop chronic diseases like high blood pressure, diabetes, chronic kidney disease and high cholesterol, and they may also be more susceptible to other drugs and environmental stressors. This prenatal exposure can permanently change how the body handles a second exposure to opioids.”

As adults, rats exposed to drugs in the womb had higher blood pressure, poorer blood sugar control and increased levels of bad cholesterol despite eating the same type of diet as the nondrug-exposed rats. The researchers also observed differences in the expression of certain proteins and receptors involved in regulating how the brain responds to drugs, raising the possibility that people exposed to opioids in the womb may also face a higher risk of drug dependence later in life.

The study draws attention to the effects of the opioid epidemic on childbearing women and the importance of screening for prenatal opioid exposure. Researchers say that knowing more about such exposures could help to inform disease prevention and treatment approaches throughout the lifespan.

Researchers presented their work in April to the American Physiological Society. The study was published in the American Heart Association’s journal Hypertension, online here.

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Kentucky's Covid-19 death rate lower than U.S. average when adjusted for health conditions and average ages in the states

Rates before (L) and after (R) adjustment for conditions; click image to enlarge

By Melissa Patrick
Kentucky Health News

Now that Covid-19 has gone beyond the pandemic phase to the endemic phase, how did Kentucky handle the pandemic? A study has found that Kentucky's coronavirus infection rate and Covid-19 death rate were above the national averages, but the death rate was below average when states' rates were adjusted for their residents' health conditions and average age.

“It is encouraging that the authors found that Kentucky outperformed in preventing Covid-19 deaths relative to the health status of our population," state Health Commissioner Steven Stack said in an email response to Kentucky Health News's request for comment.

"It’s important we remain mindful, however, that more than 18,000 Kentuckians have died from Covid-19 and that our shared journey has been difficult," said Stack, a physician. "I am grateful, though, that Kentuckians confronted this threat together and together have overcome it while showing kindness and caring towards each other." 

The research, published in The Lancet, a British medical journal, aimed to compare the states' successes in mitigating the impact of Covid-19. 

To compare state data, the researchers, led by Thomas Bollyky of the Council on Foreign Relations and Emma Castro of the Institute for Health Metrics and Evaluation at the University of Washington, standardized the Covid-19 infection rates for population density and the death rates for age and the prevalence of comorbidities, which is the existence of more than one disease or other health condition at the same time. 

They found that Kentucky's unadjusted Covid-19 death rate from January 2020 through July 2022 was 472 deaths for every 100,000 residents. But after adjusting for age and comorbidities, the rate was only 341 deaths per 100,000 population—lower than the national rate of 372. 

The state with the lowest adjusted death rate was Hawaii (147 per 100,000 residents) and the highest was Arizona (581 per 100,000).

After adjusting the rates, the researchers looked at the effect of states' characteristics before the pandemic began, such as education levels, health spending per person, state mitigation policies, and individual factors such as vaccine coverage and employment. 

Income, education, vaccines, personal trust, preventive mandates cited

The researchers found that states with low poverty rates, higher education rates and a greater share of people expressing interpersonal trust—defined as the trust that people report having in one another—had lower infection and death rates. 

States that offered access to quality health care also had fewer Covid-19 deaths and infections, but states with higher public-health spending and more public-health personnel per capita did not. 

A state's use of protective mandates were associated with lower infection rates, as were mask use, lower mobility and higher vaccination rates. And, higher vaccination rates were associated with lower death rates.

What about politics? The political affiliation of a state's governor was not associated with lower infection or death rates, but worse outcomes were associated with the proportion of a state's voters who voted for then-President Donald Trump in 2020.

Kentucky was a strong Trump state and has a Republican legislature, but has a Democratic governor, Andy Beshear, who imposed mask mandates and limitations on business activity and public gatherings.

States that did not close businesses, such as restaurants, had higher infection rates, the researchers found, based on unemployment rates: "On average, 1,574 additional infections per 10,000 population were associated in states with a one percentage point increase in the employment rate."

State policies were a factor, the researchers wrote: "States' struggles in the Covid-19 pandemic were not inevitable. The nearly four-fold differences that existed across states in Covid-19 death rates, even when standardized for factors such as age and comorbidities, suggest that lower death rates were achievable." 

The researchers added that while "Covid-19 magnified the polarization and persistent social, economic, and racial inequities that already existed across U.S. society . . . the next pandemic threat need not do the same. U.S. states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society, were able to match the best-performing nations in minimizing Covid-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises." 

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2023 Healthy Kentucky Champion nominations are due May 1

The deadline to nominate someone for a 2023 Healthy Kentucky Champion award is Monday, May 1. 

The award, sponsored by the Foundation for a Health Kentucky, is meant to recognize people leading the change to improve the health of Kentuckians.

The foundation offers some guidelines for whom to consider: 

• A Kentuckian who has invested time, energy and dedication to improving the health of their community and/or the Commonwealth.
• A leader who has demonstrated their commitment by advancing programs, research, policy advocacy, and/or initiatives to address unmet health needs of Kentuckians.
• An exceptional person who has participated, led and/or mentored others in efforts to address and reduce health risks and disparities and promote health equity in Kentucky.

Click here for the nomination form and to view a 20-minute webinar that answers questions about the program.

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Only 1 in 5 Kentuckians at risk for mpox are vaccinated for it

By Sarah Ladd
Kentucky Lantern

About one in five Kentuckians who are at risk for mpox — formerly called monkeypox — are vaccinated for it, according to Gov. Andy Beshear.

The estimated at-risk population in Kentucky is 19,344 people, Beshear said April 7. Of those, 21% got one dose of vaccine and 12% got two doses, compared to 37% and 23% nationally.

Mpox (Getty Images photo via Centers for Disease Control and Prevention)

Mpox is characterized by rashes, swollen lymph nodes, fever, cold-like symptoms and more. The disease comes from a virus in the smallpox family.

Mpox spreads through close contact with an infected person, including sex, kissing, hugging and other intimate contact.

An mpox victim is contagious until their scabs fall off and new skin forms underneath, according to the Centers for Disease Control and Prevention.

Those at higher risk for severe outcomes from mpox, according to the CDC, are those younger than 1 year old, pregnant people, the immunocompromised and people who have had atopic dermatitis or eczema.

The CDC reported that Kentucky had 104 cases as of March 29. The only neighboring state with fewer was West Virginia, with 12 cases.

“We have these (vaccine) doses available for those who are interested,” Beshear said.

For a full list of Kentucky’s health departments offering vaccines, visit: https://www.chfs.ky.gov/agencies/dph/dehp/idb/Documents/MPXVaxLocations.pdf.

The World Health Organization renamed mpox after concerns of “racist and stigmatizing language” associated with the former name.

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Doctor shortages persist in rural America, including Kentucky, and medical residency programs are scarce in rural areas

Centre for Economic Policy Research image

One of the best ways to increase the number of doctors in rural areas is to provide medical residency training there. Kentucky has seen a concerted effort to expand rural residency programs, but their number remains relatively small in the state and nation.

"Experts say expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors — including more than half of family medicine physicians — settle within 100 miles of where they train," Jazmin Orozco Rodriguez reports for KFF Health News. "And while the number of training programs has increased in rural areas during the past few years, research shows 98% of residencies nationwide are in urban areas."

In Kentucky, fewer than 20 of the state's 154 accredited residency programs, listed by specialty, are outside Lexington and Louisville. Seven of them are for family medicine and can be found in Somerset, Owensboro, Edgewood, Hazard, Glasgow, Madisonville and Morehead.  

Rodriguez tells the story of a residency training program in rural northeastern Nevada that is preparing to close, where one resident physician said she must now leave a program that she chose because she knew she would be filling a need and the patients under the care of the residents must now seek care elsewhere, often in emergency departments, 

The program, established in 2017, is shutting for a variety of reasons, including financial struggles, lack of a united support system, and a historical lack of health-care investment in the area, Rodrigue reports. 

The closure of such programs in rural areas only adds to the problem of accessing primary care, which Rodriguez reports impacts more than 100 million people in the U.S., a number that has nearly doubled since 2014.  Further, she writes that provider shortages only got worse during the pandemic, especially in rural areas, which have long struggled to recruit and retain doctors and other health professionals. 

According to the Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers. 

Members of Congress have introduced bills to address the health care provider shortage, but to no avail. Meanwhile,  rural medical training programs need more state and federal investment to grow and remain sustainable, Dr. Emily Hawes, associate professor at the University of North Carolina-Chapel Hill School of Medicine, told Rodriguez. 

A federal law fully implemented in 2019 creates more flexibility in funding and accreditation for rural hospitals wanting to establish residency programs. It has sent more than $43 million to 58 organizations in 32 states to state rural residency programs. "As of last fall, the recipients had created 32 accredited training programs in family medicine, internal medicine, psychiatry, and general surgery, and received approval for more than 400 new residency positions in rural areas," reports Rodriguez. 

But it’s not enough, Hawes said. She said a big challenge is that Medicare and Medicaid don't reimburse rural hospitals for residency programs at the same rate they do urban hospitals, despite similar or higher costs. 

Kentucky has passed legislation toward improving the health care workforce in the state. In the most recent legislative session, a bill passed to create the Health Care Workforce Investment Fund, which would use private and public money to increase scholarship opportunities.  Also, a bill to let advanced practice registered nurses prescribe controlled substances on their own after four years passed, which is expected to increase health care access in rural parts of the state.

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UK environmental-health scientist Erin Haynes leads study in Ohio to track health impact of train derailment in East Palestine

Erin Haynes (University of Kentucky photo)

A University of Kentucky environmental scientist is taking steps to learn more about the health symptoms and exposures faced by the residents of East Palestine, Ohio, following a train derailment through an online health tracking survey.

On Feb. 3, a train carrying hazardous materials derailed near East Palestine, raising concerns about both short- and long-term impacts on the health of the area’s residents.

Erin Haynes, chair of the Department of Epidemiology and Environmental Health at the College of Public Health, is leading the research for this project. 

“It’s important that we characterize the health symptoms and exposure concerns from residents in East Palestine and in the surrounding area,” Haynes said in a UK news release. “We do not know exactly how far the chemicals have spread, so we want to include all surrounding counties in this survey.”

The survey is open to anyone aged 18 or older who lives in Columbiana, Mahoning, Stark, Carroll and Jefferson Counties in Ohio and residents of Beaver and Lawrence Counties in Pennsylvania and Hancock County, West Virginia. The survey asks questions about their experiences during the evacuation, concerns about exposures and health symptoms, including stress. 

Residents’ responses will give the research team insight on the experiences and health symptoms they have been facing since the incident. 

The release notes that this survey is the first part of a long-term research study to assess the potential lingering health effects from the toxic chemicals released and formed from the derailment and the subsequent controlled burn of chemicals.

“I have worked with Dr. Haynes for over 10 years on several environmental health projects,” Amanda Kiger, resident of East Palestine, said in the release. “We are excited to see this much-needed health survey launch. The community needs this long-term follow up to assess their health over time.”

Haynes is also the Kurt W. Deuschle Professor of Preventive Medicine and Environmental Health, director of the UK Center for the Environment and deputy director of the UK Center for Appalachian Research in Environmental Sciences (UK-CARES). 

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Overdose deaths in Ky. workplaces tripled in 2019-2021; in the latter year they were the 2nd leading cause of occupational fatality

Graph by Kentucky Injury Prevention Research Center

Drug-overdose deaths in Kentucky workplaces tripled from 2019 to 2021, according to the latest annual report from the Kentucky Fatality Assessment and Control Evaluation program.The program, part of the Kentucky Injury Prevention and Research Center, found that from 2017 to 2021, the state had 47 overdose fatalities in the workplace, reaching its highest number ever of 18 fatalities in 2021. That was a 260 percent increase from 2017.

Of the 96 occupational fatalities recorded in Kentucky in 2021, drug-overdose deaths accounted for 19%, an increase from 13% in 2020 and 8% in 2019. That put overdose deaths second to motor-vehicle crashes, which were 29% of the total. In third place (17%) were "struck by" and "striking against" injuries, forcible contact or impact with an object that creates an injury.

Most of the occupational drug-overdose deaths in 2017-2021 occurred in the trade, transportation and utilities industries (38%), followed by manufacturing (19%), construction (19%) and the leisure and hospitality industry (11%). The remaining 13% took place in services and public administration.

The report notes that all of the occupational overdose deaths in the leisure and hospitality industries happened in 2020 and 2021.

It also points to the jump of occupational-overdose deaths in Jefferson County. In 2021, seven of the state's occupational overdose deaths, nearly 40% of the total, occurred in Jefferson County. That was one short of the total for the previous four years combined.

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Drinking while pregnant can have long-lasting effects on children; almost half of pregnant Kentuckians report alcohol consumption

Centers for Disease Control and Prevention illustration

Did you know that children of mothers who drink alcohol during pregnancy can undergo changes to their facial features, accompanied by a variety of lifelong mental and physical challenges? And some of those changes may not be visible. Exposure to alcohol before birth can also affect systems throughout the body and have lasting impact, Emma Yasinski reports for National Geographic.

"Studies have estimated that fetal alcohol spectrum disorders, or FASD, affect between 1 and 5 percent of the population, though experts suspect the prevalence is even higher," Yasinski reports. 

The FASD United Policy and Training Center website says FASD is the "most commonly known cause of developmental disabilities in the United States," and recent research shows up to one in 20 first graders have a disability from it.

Almost half of Kentucky women with a recent live birth consumed alcohol during the three months before pregnancy. The figure was 48.7% in 2019, according to the America's Health Rankings report from the United Health Foundation. The national rate was even worse, 56.7%.  

FASD-related problems

It wasn't until the early 1970s that researchers found a pattern among babies born to mothers with severe alcohol-use disorders, including hallmark facial features such as a smooth upper lip, a small head, and a flat nasal bridge. These features were generally accompanied by a variety of lifelong mental and physical challenges such as learning disabilities, difficulty reasoning, growth deficiencies, and heart and kidney problems," Yasinski reports.

Since then, researchers have found that prenatal alcohol exposure can disrupt development of the brain and body even without affecting the face, and include a broad range of conditions that are often inconsistent from one patient to another. Yasinski also delves into the details of how FASD changes the brain. 

The FASD center says people with the disorder often have difficulty learning and remembering, understanding and following directions, shifting attention, controlling emotions and impulsivity, communicating and socializing, and performing daily life skills. It says FASD cases are seriously under-diagnosed and often hard to distinguish from other developmental disorders. 

Further, Yasinski reports that diagnosis requires complex tests and treatments that, due to limited resources and awareness, many patients never get.

“Alcohol affects the brain in different ways, depending on when the brain is exposed in pregnancy and how much it's exposed, and what else is going on, like nutritional factors, genetic factors, other things about the mom and the fetus,” Jeffrey Wozniak, a neurobehavioral development researcher at the University of Minnesota, told Yasinski. “So there's a lot of variety in terms of the brain effects.”

How prevalent is drinking during pregnancy? 

According to Kentucky's 2020 births report from the Public Health Neonatal Abstinence Syndrome Reporting Registry, "Alcohol use was reported by mothers of 4.8% of infants with NAS in Kentucky, which may be lower than the actual rate of use."

Centers for Disease Control and Prevention data show that in 2018-20, 13.5% of pregnant U.S. adults reported that they were currently drinking and 5.2% reported they had engaged in binge drinking.

Many women drink without knowing they are pregnant, and that harm a fetus. About half of all U.S. pregnancies are unintended, and most women don't know they are pregnant until four to six weeks into the pregnancy.

While binge drinking and regular heavy drinking put a fetus at the greatest risk for sever problems, even lesser amounts can also cause damage, says the National Institute on Alcohol Abuse and Alcoholism. 

"In fact, there is no known safe level of alcohol consumption during pregnancy" says the institute. 

Looking forward

The good news is that in the early 2000s, "Studies started to show that targeted therapies could help people who were prenatally exposed to alcohol," Yasinski reports.  

For example, Julie Kable, a neurodevelopmental exposure researcher at Emory University in Atlanta, told Yasinski that she and her team found with the CDC that offering adaptive support helped people with FASD better learn and understand math. Yasinski says researchers have also found ways to help people with FASD with executive function and decision making. 

Kanle told Yasinski, “No longer could we allow pediatricians to say, Well, why should I diagnose it when there's nothing we can do about it?”

But Yasinski reports that the U.S. has too few places that can diagnoise FASD, "and some states don’t even have a single FASD diagnostic center. Since diagnosis requires comprehensive evaluations, the centers that do exist have limited capacity to complete them. Many will only see patients who they know were very likely to have been exposed to alcohol in utero, which accounts for a fraction of those believed to be affected."

She adds,, "While most experts agree on the basic characteristics of FASD, there are also minor differences in diagnostic criteria between states, countries, and clinics, with slightly different cutoffs."  And this, she reports "can create challenges for researchers working to build large data sets, but it also has more immediate impact." For example, one FASD specialist told her that individuals with FASD in some states don't qualify for disability services because " the CDC only has consistent diagnostic criteria for fetal alcohol syndrome, not the whole spectrum of disorders." 

Some in Congress are working to provide resources for screening, research and other supportive services for people with FASD, in a bill called the FASD Respect Act. The FASD United Policy and Training Center says a new version of this bill is to be introduced.

Susan Shepard Carlson, who was a district court judge and first lady of Minnesota, told Yasinski that she is advocating for this bill largely because she realized in 1997 that a many children coming through the courts "had the same kind of profile [as] someone with FASD . . . but we weren't really looking at the underlying cause." 

Because of this, Carlson convened a task force that led to the state funding FASD research and treatment. "The court was able to screen children suspected of having an undiagnosed FASD, and she says about 25 percent of the kids they chose to screen did have an undiagnosed disorder," writes Yasinski.

Kable told Yasinski, “It’s really important to know that we can still have dramatic differences in the developmental outcome of these children, if we get them recognized, and get them services as early as possible.” 

Information for this story was also gathered by Melissa Patrick of Kentucky Health News.

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Medicare Advantage TV ads and other marketing will have to follow new rules aimed at stopping deception of beneficiaries

Cover of report asking Medicare to act

Kentucky Health News

Those incessant ads and phone calls about Medicare, and other marketing devices that the federal government considers deceptive, are about to get makeovers. At least that's what the feds have in mind.

On April 5, the Centers for Medicare and Medicaid Services "finalized a slew of Medicare Advantage marketing reforms for the upcoming 2024 Medicare open enrollment season, including plans to crack down on general television advertisements after concerns over such marketing kicked into high gear last year, Michalle M. Stein reports for Inside Health Policy.

CMS said last fall that it was worried about marketing practices, particularly concerned about TV commercials for Medicare Advantage, which most Medicare beneficiaries now have. Private insurance companies run MA plans, making money by getting a flat fee from Medicare for covering each beneficiary, then controlling costs by limiting claims payments and taking other measures.

"The Senate Finance Committee fanned those flames with a report that alleged bad actors in 14 states were taking advantage of loopholes and lax rules around marketing and enrollment, “badgering seniors on the phone, confusing them on television, and inundating them with mountains of mail,” and noting complaints to CMS doubled between 2020 and 2021.

"Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments," the report said, calling the ads deceptive. It urged CMS to act.

CMS said, “The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan.”

The proposed regulations would, also require insurers to:

• Notifying enrollees annually and in writing of their ability to opt out of phone calls regarding Medicare Advantage and Part D;
• Explain the effect of an enrollee’s enrollment choice on their current coverage when they make an enrollment decision;
• Simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of plans’ Summary of Benefits;
• Ban marketing of savings information based on a comparison of typical expenses for uninsured individuals or the unpaid costs of beneficiaries eligible for both Medicare and Medicaid;
• Limit the use of the Medicare name, logo and card in ads.

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UK is ‘Centering and Celebrating Cultures in Health’ during National Public Health Week, which runs through Sunday

Advocates celebrated a National Public Health Week at the University of Kentucky.

By Grace Colville

University of Kentucky

From fostering collaborations to increase lifesaving cancer screenings, to examining the impact of an environmental disaster, to shedding light on vaccine hesitancy in Eastern Kentucky, experts in public health are all around us, seeking ways to improve and health and well-being of the population.

April 3 marks the beginning of the annual National Public Health Week, a time to recognize the contributions of public health and highlight issues that are important to improving our nation's health. This week, organizations across the country — including the University of Kentucky College of Public Health — are hosting events to promote public health's passion, purpose and pathway for a healthier life.

Each year, a different theme is chosen to recognize and celebrate public health in a different capacity. This year, the theme is "Centering and Celebrating Cultures in Health." The goal of this theme is to celebrate how we learn from the communities we are born in and the ones we build together.

“This year’s theme means inclusiveness and coming together,” said Acting College of Public Health Dean Heather Bush. “We feel strongly that community is a big part of what we do in public health and we see essential value in hearing from communities.”

“Everyone belongs here,” said Jonathan Gent, chief of staff at the college and organizer of UK’s National Public Health Week events. “Inclusive excellence is only possible with diversity of thought and creating a welcoming atmosphere — for everyone. We aim to be a champion of diversity, equity and inclusion, in line with our vision to be the catalyst of positive change for population health for all.”

The UK College of Public Health has been celebrating National Public Health Week for nearly 20 years. Its mission of developing health champions, conducting multidisciplinary and applied research and collaborating with partners to improve health in Kentucky and beyond is furthered by awareness of the field and support of its patrons.

“National Public Health Week is about celebrating our public health heroes and champions. It’s about taking time to say thank you,” said Bush. “Communities matter and what happens in our communities is important. We are all part of coming together for a solution. We recognize that groups of people are different and what makes them different is beautiful. We want to celebrate and recognize those differences, and use that for our understanding in what makes public health great.”

This week, UK has multiple events open to all students, faculty, staff and community members. These virtual and in-person events will allow attendees to explore the role of strong communities on physical and mental health. The events include:

Tuesday, April 4: Music Bingo | 3:30-5:30 p.m. College of Public Health, Room 115
Music bingo is very popular for relaxation and mental health. It's just like regular bingo, but instead of shouting out numbers, songs are played. Each round takes on a different genre of song choices; these could be based on either a decade, theme or just a random quirky topic (for example, movie theme tunes or Disney songs). Prizes are available for winners.
Facilitated by the Office of Student Engagement and Academic Success (SEAS) within the College of Public Health.

April 4: Mennonite Population of Kentucky and Celebrating Care | 2-3 p.m., Virtual (Zoom Link)
Facilitated by Jenn Harris, director of the Todd County Health Department, and M. Susan Jones, professor emerita, School of Nursing, Institute for Rural Health at Western Kentucky University.
Kentucky's Mennonite populations is listed as the eighth largest in North America, one of the fastest growing in the past 20 years. What is it like to work with such a unique culture within our own borders? What can health care students learn from this population? How can we celebrate the care given to this population?

Wednesday, April 5: Yoga Therapy | 3-4 p.m. Wethington Commons, Room 127
Enjoy this therapeutic experience, which empowers individuals to progress toward improved health and well-being through the application of the teachings and practices of yoga. No experience? No problem! Bring your mat and move at your own pace for a stress-busting round of yoga.
Facilitated by UK Campus Recreation and Wellness.

Thursday, April 6: Express Your Culture Through Art | 8:30 a.m.-4 p.m. CPH Room 120
Using the materials provided, express how your culture has shaped your health. Think about the foods you eat, the traditions you have with your family and friends or your community, the activities and hobbies you engage in, or how you unwind and decompress.

April 6: Move Your Body Today | 11 a.m.-noon, Bradley Bowman Quad
Stop by for a fun, body-weight workout that you can do anywhere. Also, learn ways to engage and motivate others into daily physical activity. Facilitated by Ketrell McWhorter, assistant professor, UK College of Public Health, American Council on Exercise certified personal trainer.

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Fentanyl test strips will no longer be drug paraphernalia under law

By Sarah Ladd
Kentucky Lantern

Fentanyl test strips will no longer be considered drug paraphernalia in Kentucky.

Gov. Andy Beshear on Friday signed a bipartisan bill decriminalizing fentanyl test strips in Kentucky after it easily passed both legislative chambers.

The state Senate passed House Bill 353 Thursday night. The House concurred unanimously in the final hours of the legislative session. It will take effect July 8, 90 days after the session's adjournment.

How one type of fentanyl test strip works

Fentanyl test strips are paper strips that can detect the presence of fentanyl in pills and other drugs within minutes. Fentanyl is a powerful synthetic opioid that contributed to 73% of Kentucky’s 2,250 overdoses in 2021. Using the test strips can help prevent overdoses, the Centers for Disease Control and Prevention says.

“Unwitting individuals may think they are ingesting one substance and unaware that it also contains fentanyl,” Jennifer Hancock, president and CEO of Volunteers of America Mid-States, said in a statement.

“With police departments and other emergency responders already carrying and administering Narcan, a medicine used for the treatment of a known or suspected opioid overdose emergency, it makes sense to prevent these overdoses on the front end,” she said. “It may afford another day where we can get an individual into recovery.”

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Appalachian Nursing Academy for high school juniors and seniors in Appalachian counties extends application deadline to April 15

The Appalachian Nursing Academy, for high school students in Appalachia who are wondering if they would like to pursue a career in health care, has extended its application deadline to April 15. 

The academy is a free, two-week summer program at the University of Pikeville July 10-21. It is available to rising junior or senior high school students who reside in one of Kentucky's 54 Appalachian counties. 

Those counties are Adair, Bath, Bell, Boyd, Breathitt, Carter, Casey, Clark, Clay, Clinton, Cumberland, Edmonson, Elliott, Estill, Fleming, Floyd, Garrard, Green, Greenup, Harlan, Hart, Jackson, Johnson, Knott, Knox, Laurel, Lawrence, Lee, Leslie, Letcher, Lewis, Lincoln, McCreary, Madison, Magoffin, Martin, Menifee, Metcalfe, Monroe, Montgomery, Morgan, Nicholas, Owsley, Perry, Pike, Powell, Pulaski, Robertson, Rockcastle, Rowan, Russell, Wayne, Whitley, and Wolfe. 

Participants of the academy are required to attend the entire program and participate in a year-long mentorship program following the academy. Those who complete the program will also receive a $1,500 scholarship to any college or university of their choice.

Participants will receive housing, three meals a day, interactive programming and trips to see regional attractions and activities. 

To apply, students will need to submit a permission form, a completed application, a copy of their unofficial transcript and a letter of recommendation. Click here for more information. Click here for answers to frequently asked questions. Applications will close Saturday, April 15 at 11:59 p.m. ET.

The academy is sponsored by Shaping Our Appalachian Region in partnership with the state Department for Public Health and the university. This is the second time the academy has been offered. 

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Every Kentucky county has a low risk of Covid-19 transmission

CDC map shows all Kentucky counties and all but one adjoining county (Scott County, Tennessee)
at low risk, with the closest high-risk counties in northeast Missouri and West Virginia.

By Melissa Patrick
Kentucky Health News

Every county in Kentucky has a low risk of Covid-19 transmission, according to the latest weekly analysis of risk based on new cases and hospital capacity by the Centers for Disease Control and Prevention. 

The latest map shows the whole state is in green, a level that comes with recommendations to stay up to date with your Covid-19 vaccines and to avoid contact with people who have suspected or confirmed Covid-19. 

So does that mean the pandemic is over? The answer is, not yet. However, the leader of the World Health Organization said mid-March that he expects that the organization will declare an end to it later this year, WebMD reports. President Biden is letting the public-health emergency expire in May 11.

“I am confident that this year we will be able to say that Covid-19 is over as a public health emergency of international concern,” WHO Director General Tedros Adhanom Ghebreyesus told reporters at a Geneva briefing.

CDC map shows transmission levels of the virus.

The CDC also provides a community level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows six counties with a low level of transmission and 53 with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

On March 31, The New York Times, using CDC data, found Kentucky's new-case rate to be the 19th highest in the nation, at 46 coronavirus cases per 100,000 residents in the last seven days. 

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