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Friday, June 4, 2021

Cameron sues CVS Health, saying that as distributor and retailer it was in a unique position to stop opioid epidemic and didn't

CVS Health is the latest major drug company to face a lawsuit from Kentucky's attorney general, alleging that it was partly responsible for the opioid epidemic.

Attorney General Daniel Cameron filed the suit Wednesday in Franklin Circuit Court. It alleges that the company "failed to guard against the diversion of opioids" to illegal purposes, a Cameron press release said.

“During the height of the opioid epidemic, CVS allowed millions of dosage units of opioids to flood Kentucky’s borders, fueling the crisis and devastating thousands of families and communities,” Cameron said. “As both distributor and pharmacy, CVS was in a unique position to monitor and stop the peddling of these highly addictive drugs from their stores.”

Cameron said CVS accounted for 6 percent of the dosage units of oxycodone and hydrocodone in Kentucky from 2006 to 2014. "One CVS store, located in Perry County, purchased over 6.8 million dosage units of oxycodone and hydrocodone from 2006 to 2014, which was enough opioids for every man, woman, and child in the county to have over 26 pills every year during the same period," the release said. "A CVS in Crittenden County bought over 2.8 million dosage units of the drugs, enough to supply everyone in the county with over 34 pills every year."

The suit says CVS reported no suspicious orders for its Kentucky stores from 2007 to 2014, and worked with other companies such as Purdue Pharma and Endo Pharmaceuticals "in the marketing, advertising, and promotion of opioid products" and "improperly normalized the widespread use of opioids by participating in these efforts."

Purdue Pharma, the maker of OxyContin, and other drug companies were sued by Andy Beshear, now governor, when he was attorney general. It and Mallinckrodt Pharmaceuticals are in bankruptcy, and the state's claims against them "are progressing toward resolution later this year," Cameron's release said. It said he continues to pursue suits against Endo, Walgreens and Teva Pharmaceuticals, and is in settlement talks with Johnson & Johnson, McKesson Corp., Cardinal Health and AmerisourceBergen.

Beshear starts incentives to get people vaccinated, including 15 scholarships for students 12-17 and three $1 million drawings

By Melissa Patrick
Kentucky Health News

As coronavirus vaccination rates in Kentucky keep slowing, Gov. Andy Beshear has announced new lottery-style incentives: $1 million each for three residents who have received at least one dose, and 15 education scholarships for children between the ages of 12 and 17 who have received at least one shot. 

Beshear announces incentives. (Photo by Melissa Patrick)
"We know Covid vaccines are life-saving. And now, for some people, they're going to be life-changing," Beshear said at a Friday news conference in the Capitol rotunda. In Kentucky, the daily number of vaccines given has dropped below 10,000, and the last seven days saw 44% fewer shots than the week before. The New York Times estimates that at the current rate, it will take Kentucky about two months to get 70% of its adults vaccinated with at least one dose. 

Beshear said he expects the incentives will result in a "significant increase" of vaccinations, noting that Ohio's similar $5 million sweepstakes saw a nearly 30% spike in vaccinations after its rollout. 

Statewide, 46.7% of Kentuckians have received at least one shot, 57% of adults have had at least one, and 38.7% are fully vaccinated.

The drawings will be held July 1, July 29 and Aug. 26 and winners will be announced the day after the drawings, on July 2, July 30 and Aug. 27. The last date to enter for each drawing is the day before the drawings.

Beshear said the money for the "Shot At a Million" drawings will come from the federal government's initial coronavirus relief funds.

Entry into the drawings are free and must be completed at shotatamillion.ky.gov, or by calling 855-598-2246 to enter. Once a person enters for a drawing, they will be eligible for all future drawings. 

Entry requires your name, birthdate, email address, phone number, home address and the name and location of your vaccination. Participants must agree to the rules and agree to have their vaccination information verified. 

Entry for the scholarship drawings has additional requirements: a parent or guardian’s name, email address and phone number. The scholarships can be used at a Kentucky public college, university or technical or trade school and will include tuition, room-and-board and books. 

"If you've already gotten your shot, good for you, you're eligible. All you have to do is sign up," Beshear said. "If you haven't gotten your shot, well get it. Protect your family and get qualified for this amazing opportunity." 

Go to vaccine.ky.gov to find a vaccination site. 

Not eligible for the incentives are non-residents of Kentucky; inmates incarcerated for a felony; employees of the governor's office, the Cabinet for Health and Family Services, the Kentucky Higher Education Assistance Authority and Kentucky Interactive LLC, and blood relatives, spouses or household members of such employees.

Kentucky Health News asked if there had been talk of offering incentives to counties with low vaccination rates, such as the 21 that are less than 25% fully vaccinated or those along the southern border, where rates are like the low rates in Southern states, putting them at risk of more contagious variants. 

Beshear acknowledged that the lower vaccination rates in Tennessee affect the border counties, and noted that it is important that every county gets the same information about the vaccines. He said in a call with judge-executives this week, the state asked to bring a vaccine mobile unit to all their festivals. 

The governor said offering incentives on a different scale could be an option, and added that local governments could use some of their recent American Rescue Plan Act money for such incentives. 

Eviction Relief Fund: Beshear announced that Lexington will get $11.7 million and Louisville $27 million for their eviction relief programs because they received fewer federal funds for them than expected.

The state got $264 million for its emergency rental assistance program and, working with partners, has processed over $18 million to landlords and utilities on behalf of 2,800 renter households, a news release said. All funds must be spent by Sept. 30, 2025. For more information visit https://teamkyhherf.ky.gov/.

Spencer residents cite mistrust of government, worry about side effects and links to abortion as reasons they're not vaccinated

Spencer County stands out in an adapted screenshot of the Dept. for Public Health interactive map.
By Melissa Patrick
Kentucky Health News

Twenty-one of Kentucky's 120 counties have one-fourth or fewer of their residents fully vaccinated against the coronavirus, and at 16.4%, Spencer County ranks last. In the percentage of residents who have received at least one dose of a vaccine, ties for last slot with Christian County, at 20%. 

Spencer stands out on the state's map of vaccination rates; every county close to it has a much higher rate. What makes the county of about 20,000 so different?

During interviews in the parking lot of Country Mart in Taylorsville, population 1,300 and the county's only town, several reasons rose to the top.

They included not wanting the government telling them what to do, concerns about potential long-term effects and side-effects of the vaccine, and not wanting to take a vaccine that is connected in any way to abortion. 

Sean Lawson, 55, said, "I will not have baby parts injected into me." A 55-year-old businesswoman who would not give her name said likewise, and was one of several who spoke passionately about not trusting government and disliking its instructions. "I don't know who I can trust," she said.

The resistance to government advice is not surprising in a county that has been Kentucky's fastest-growing in the last 40 years because it offers a rural, lightly regulated lifestyle close to Louisville. A 20-year-old man who declined to give his name said he thought the independent "country spirit" of local residents played a role.

Doubts, beliefs and facts

The mistaken belief about "baby parts" stems from the use of fetal cell lines in the development and manufacture of the coronavirus vaccines. Experts say the cells are not the same thing as fetal tissue, Healthline reports.

According to Dr. Aleena Banerji, a member of the American College of Allergy, Asthma & Immunology  Covid-19 Vaccine Task Force, fetal cells were obtained from elective abortions in the 1970s and 1980s and have been grown as cell lines in laboratories for 30 to 40 years. They are used in vaccine research because viruses need human cells in which to replicate.

Banerji said neither Pfizer nor Moderna used fetal cell lines in development or production of its coronavirus vaccines, "so there are no fetal cells in the vaccine," but did use them to make sure the vaccine worked before beginning clinical trials in humans. She said the Johnson & Johnson one-dose vaccine used a fetal cell line in development and manufacturing.

Lawson said he didn't think people wanted a coronavirus vaccine because the county's case numbers were so low and because people aren't worrying about dying from it, since the survival rate is 98%. He also said he doesn't worry about the virus because he "is protected by God."

Spencer County's rate of new cases over the last seven days is not low, compared to the rest of Kentucky. It is 5.3 per 100,000 people, slightly higher than the statewide rate of 4.5.

Overall, however, the county's rate has been lower than the state's. It has had 1,636 cases, 0.36% of the state's total, and 25 of the state's 7,077 deaths, or 0.35%; the county has 0.45% of the state's population.

While most of the people interviewed did not want to share their name, no one turned down the opportunity to say why they thought the county's vaccine rate was so low and why they are part of that.

Some said they had not gotten vaccinated because they had already had the virus, which gives them natural immunity. (Just how much immunity, and how long its lasts, are unknown.) Others in this group said they were suffering lasting symptoms, even though they began several months ago, and that had made them nervous about getting a shot.

Various reasons

Several said they thought people weren't getting vaccinated because of how fast the vaccines were developed, and because it was too new. 

"It's not old enough for me yet," said a 37-year-old woman who said she had other health conditions to consider. "I'm not against vaccines and I don't think anybody is against vaccines; I just think it is such a new vaccine." 

Pinkston said he has had the virus, and "I have no faith at all in a vaccine developed in six months."

He offered many other reasons, including this: "Biblically, it is just a step away from the mark of the Beast," the Antichrist figure in the New Testament book of Revelation. "When they start talking about how they wanted to identify people somehow once they've had it, with a chip or whatever. . . . It's not there now, but it's a step away."

The vaccines do not contain microchips or other such devices, and Gov. Andy Beshear has said the state will not require proof of vaccination.

One 48-year-old man said he and his family had planned on getting the Johnson & Johnson vaccine, but after it was temporarily halted because one or two in a million recipients, all women of child-bearing age, developed a peculiar type of blood clot, they decided "to give it some more time."

Several people said they had gotten a vaccine and wish everyone else would too. "I tell everybody, get vaccinated as soon as you possibly can because people are still getting infected and people are still dying every single day," said Clarence E Keith Jr., 71.

Spencer County is in the North Central District Health Department, which also includes Shelby, Henry and Trimble counties. In an effort to learn why people in the district are not getting vaccinated, the department is conducting an anonymous six question survey on its Facebook page. Results from the survey will be shared on social media, said Stephanie Lokits, the agency's nursing director. 

Nearly all of those interviewed in Taylorsville said the county's low vaccination rate had nothing to do with a lack of access. 

Spencer County has at least four places to get a free coronavirus vaccine, including the health department, a community health center and two pharmacies.  The health department has also hosted a drive-through clinic and Taylorsville Community Health Center is hosting one on June 12 from 8 a.m. to 3 p.m. The vaccines are free for anyone 12 and older, and no appointment is needed. 

John Shindlebower, longtime editor of The Spencer Magnet, said vaccination has not been a hot issue for his readers. He said that even after the paper published several stories about the county's low vaccination rate, it only got one letter urging people to get vaccinated. 

"We've not heard a lot of opinion one way or the other about the vaccine," he said. 

Nearby Franklin and Woodford counties have the highest rates of fully vaccinated people, with half of their populations fully vaccinated and 60% or more of them with at least one dose of a vaccine.  Statewide, 46.7 % of Kentuckians have received at least one shot, 57% of adults have had at least one shot, and 38.7% are fully vaccinated.

Lokits said the health department keeps trying to find ways to encourage vaccination. Most recently, it did clinics at all the county's public schools. It is also offering on-site vaccine clinics for groups and businesses and have distributed yard signs with fact-based messaging to quell misinformation. 

Anti-misinformation signs are in English and Spanish
"We're continuing to share information on social media about vaccinations, just trying to get the information out there to folks," she said. "You know, there's so many myths out there about the vaccine, and so many things that people really don't understand." 

One of those myths is that the vaccines are not safe. Lokits said it's important for people to know that the health department has given over 13,000 doses of the vaccine and not one person has had a reaction that required hospitalization. 

Lokits said they also give vaccines on Thursdays to anyone who signs up for one, but only about five people show up each week. She said some people may be getting their shots in Jefferson County, since that's where most Spencer County residents work.

Vaccines going unused

Cassandra Yates, charge nurse at the Taylorsville Community Health Center, said it offers the vaccine to all of their patients, but has only given about 70 vaccine doses in the last three weeks and has no one on its waiting list. "People just don't want to get it," she said.

Yates said that when they offer the vaccine, younger patients have been less likely to take it than older ones, and those who refuse usually don't want a flu shot either. 

She said she thinks one reason people refuse is because they don't have a mindset to get preventive vaccinations once they become adults: "They are just not going to do it."  

Yates added that the recent lifting of the state mask mandate, and plans to drop all restrictions June 11, sent a message that the pandemic is over, which makes some people less likely to get a vaccine. 

Alex Shields, a pharmacist at Hometown Pharmacy, said they are giving about 10 shots a week, 515 in all, and have more than 200 doses available. "I think a lot of people in our community have made their mind up to not get it," she said.

The Centers for Disease Control and Prevention vaccination report which ranks Spencer County last for fully vaccinated people only includes people who have a county of residence listed. Kentucky has 116,288 fully vaccinated residents in the report who are not assigned a county and are listed as unknown. The report says 93% of Kentucky's fully vaccinated residents are accounted for. 

The New York Times reports that at the current rate of vaccination, it will take Kentucky about two months to get 70% of its adults vaccinated with at least one dose of a vaccine.  

Click here for information about what medical and public-health experts say about some of the reason's given for Covid-19 vaccine hesitancy. Click here for the CDC's information regarding myths and facts about the Covid-19 vaccine. Click here for Covid-19 vaccine facts on the health department's Facebook page.

Thursday, June 3, 2021

Factory worker and bodybuilder, 43, is first person in Kentucky to get a double lung transplant because of damage from Covid-19

Dave Hoover and family (UK HealthCare photo)
The first Kentuckian to get a double lung transplant because of damage from the coronavirus is a 43-year-old competitive bodybuilder who is "the kind of healthy, younger person who isn’t statistically likely to develop severe complications from Covid-19," Daniel Desrochers reports for the Lexington Herald-Leader.

Read more here: https://ift.tt/2SRODPO

Dave Hoover, a factory worker and hobby farmer from Stanford, "thought it was allergies or a minor illness," Desrochers reports. "Even after he checked into the hospital, he had seemed mostly fine." But he gradually got worse, and "developed a complication from being on the respirator that allowed air to seep into his chest, so they had to catheterize his throat in order to inject oxygen directly into his veins. He was put on the lung-transplant list, where he waited for a month."

About 15 percent of those on the list don’t make it through the waiting period because too few people are organ donors, Dr. Maher Baz, medical director of lung transplants at the University of Kentucky, told Desrochers.

Hoover went home April 23 to his wife and son. "“They were very brave for this, very motivated, and that’s what kept him on his feet,” Baz told the Herald-Leader. “That’s what really got him through the waiting time, his motivation and courage.”

Photo: Hoover in a bodybuilding competition.
Read more here: https://ift.tt/2SRODPO

Wednesday, June 2, 2021

Free webinar at 1 p.m. ET Thursday, June 3, will show how rural employers can strengthen local vaccination rates

A National Rural Business Summit webinar on Thursday, June 3, will discuss how major rural employers and small businesses can engage with employees and residents to play a meaningful role in increasing the rural coronavirus vaccination rate. Strategies include sharing fact-based information, sharing personal vaccination stories, and supporting community vaccination efforts.

The free webinar will begin at 1 p.m. ET and is presented by the Rural Assembly in partnership with the Health Action Alliance, The Daily Yonder, the National Rural Health Association, The Rural America Chamber of Commerce, and other organizations. Click here to register.

In related news, a new episode of the Rural Assembly's Everywhere Radio show is all about how to overcome vaccine hesitancy in rural America. Host Whitney Kimball Coe, director of the Rural Assembly, talks with Jeff Eastman, CEO of Remote Area Medical, a nonprofit that provides free health care to those in need. Listen to the episode here.

Tuesday, June 1, 2021

Audit of death certificates ends, adds 260 Covid-19 fatalities; cases and test rates still declining, but so are vaccinations

For the first time in many months, no counties are in red. (State map, relabeled by Ky. Health News)
By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced 261 Covid-19 deaths in Kentucky on Tuesday, all but one from an audit of death certificates that he said has finally been completed. That brought the state's Covid-19 death toll to 7,067. 

“Today, we’re going to add a number of deaths to make sure that we are fully accurate,”  Beshear said at what he said would be his next-to-last news briefing focused on the pandemic. 

“I believe after today we will have conducted the most comprehensive audit of deaths in the commonwealth during this pandemic, the most comprehensive audit of anywhere in the United States,” he said.

The audit began in March, after the big winter surge of deaths and cases that overwhelmed many of the state's health departments, which do the regular reporting of Covid-19 deaths. It initially went back to October, then to the beginning of the pandemic, almost 15 months ago.

On the list released Tuesday, the first and second deaths were March 20 and 31; the last was on Oct. 26. There were six last April, 24 last May, 31 in June, 29 in July, 50 in August, 64 in September and 52 in October.

Jefferson County, which has about 18 percent of Kentucky's population and Covid-19 deaths, had 37% of the audit deaths reported Tuesday: 96 (the two in March, three in April, 11 in May, 17 in June, 11 in July 17 in August, 21 in September, 14 in October). Kenton County had 20, and Boone County had 18.

Beshear said that while the additional deaths do not change the state's Covid-19 mortality rate of 1.5%, it is important to "make sure when someone has lost someone that we recognize that pain and that loss."

Audit deaths have been reported for months; at least one was as old as August. After the briefing, Kentucky Health News asked Beshear's office why so many were delayed and provided all at once. There has been no answer.

Even some regularly reported deaths are months old, so Kentucky Health News uses a 14-day average of deaths. It was around 10 per day in early April, and after two months of fluctuations is down to 6.21 a day.

Vaccinations declining: Vaccinations in Kentucky continue to slow, according to Centers for Disease Control and Prevention data reported and analyzed by The Washington Post. In the last seven days, doses administered averaged about 12,300 doses per day, a 28% decrease over the previous week.

The state reports 2,058,029 Kentuckians have received at least one dose of a vaccine, which amounts to about 46% of the total population or 57% of the state's adult population. 

Beshear continues to encourage younger Kentuckians to get vaccinated, noting that no age group under 50 has broken the 50% mark for vaccinations. He said he would announce incentives on Thursday to those who have not yet chosen to do so. 

Woodford, Franklin, Fayette, Boone and Scott counties have the highest percentage of residents who have received at at least one dose of a coronavirus vaccine. Christian, Spencer, Ballard, McCreary and Lewis counties have the lowest percent of residents vaccinated.  

Beshear announced that Kentucky's 195 senior centers can reopen at full capacity on June 11. The governor had already set June 11 as the date for most of the state's Covid-19 restrictions to be lifted, including the mask mandate.  

“The reason that we can do that are vaccines," he said. "These things are miracles, they have effectively ended death and hospitalization for the most vulnerable. They are saving lives every single day and we've got to make sure more people get them." 

Kentucky's guidelines line up with CDC guidelines that say any fully vaccinated person does not need to wear a mask. A person is fully vaccinated if they are two weeks beyond their last dose of vaccine.  

Beshear said since the senior centers were closed in March 2020, the state has seen a 200% increase in delivery of meals to homes, and has been able to provide meals to every senior 60 and older who has wanted one. Any senior who remains in need of a meal should call 877-925-0037, he said. 

Daily numbers: Beshear reported 137 new cases of the coronavirus Tuesday, with 34, or nearly a fourth, in people 18 and under. That brought the seven-day average to 299.57, the first time it's been under 300 since July 7. The share of Kentuckians testing positive for the virus in the past seven days is 2.5%. 

Beshear said both the weekly number of cases and weekly positive-test rates have declined for four weeks in a row. (The positive-test rate has actually declined five weeks in a row.) "We're now convinced that we are on a downward trend, even if it is a small downward trend," he said. 

The statewide rate of daily new cases has fallen to 4.88 cases per 100,000 residents. The New York Times ranks Kentucky 18th among states for this measure, with a 42% decline in the last 14 days. 

Counties with rates more than double the statewide rate were Webster, 24.3; Union, 17.9; Leslie, 15.9; Casey, 13.3; Owen, 13.1; Owsley, 12.9; Rowan, 12.8; Todd ,12.8; Whitley, 12.6; Bath, 11.4; Montgomery, 11.2; Harlan, 11; Graves, 10.7; Lincoln, 10.5; Rockcastle, 10.3; Muhlenberg, 10.3; Clark, 9.8; Henderson, 9.8; and Morgan, 9.7.

Not one Kentucky county is in the "critical" zone for cases, meaning they have more than 25 cases per 100,000 residents. So no counties on the state's new-case incidence map are in red, for the first time in months.

In other pandemic news Tuesday:
  • Counties with five or more new cases were Jefferson, 32; Fayette, 12; and Lincoln, 5. 
  • Kentucky hospitals reported 324 patients Covid-19 patients, 111 of them in intensive care and 56 of those on a ventilator. 
  • The easternmost region of the state, from Pike to Lee counties, is the only hospital-readiness region using close to 80% of its intensive care unit beds, at 76.47%.
  • The vaccine dashboard shows that 58,220 Kentucky children between ages 12 and 15 have received at least one dose of a vaccine. 
  • Moderna has filed for full federal approval of its vaccine for Americans 18 and older, the company announced.

Study of 288 Covid-19 patients in Michigan found nearly half left hospital in worse physical condition than when they arrived

Image from tarponpa.com 
Coronavirus infections and Covid-19 hospitalizations and deaths continue to decline, but much remains unknown about the lingering consequences of the disease, including the loss of physical abilities, Katie Camero reports for McClatchy News.

A study of 288 patients in Michigan found that 45 percent of Covid-19 patients hospitalized during the first two months of the pandemic experienced “significant functional decline after being discharged” that required medical equipment such as canes, wheelchairs, shower seats, outpatient therapy, caregiver assistance or diet changes, Camero reports.

Of these patients, 80% were referred to physical therapy after being discharged, and nearly 20% were not able to live independently, she reports.

“Rehabilitation needs were really, really common for these patients,” lead author Dr. Alecia K. Daunter, a pediatric physiatrist at Michigan Medicine, said in a Michigan Health Lab blog. “They survived, but these people left the hospital in worse physical condition than they started.” 

The researchers say their study is a “snapshot look at acute therapy needs” of such patients at a time when health-care systems were working to “keep patients safe while maximizing available beds and minimizing exposure to staff,” lead author Dr. Alecia Daunter, a pediatric physiatrist, said on the blog. 

The researchers say more study is needed on Covid-19's long-term effects on functionality, but meanwhile, Daunter said health systems can use this data to inform rehabilitation evaluations and to create plans of care for such patients.

“Acute care therapy can help prevent contractures, preserve muscle strength, address mobility impairments and help maintain cardiorespiratory function when patients are ill,” Daunter told McClatchy News in an email.

“These problems are frequent, and the stakes are pretty high if we miss them, or allow them to progress during hospitalization,” Daunter said on the blog. “Some of these people were working and many were living independently. To lose that level of function is meaningful. We want to make sure we’re addressing those needs, not just looking at the black and white: survival or death.”

The study at the University of Michigan was published in PM&R, the journal of the American Association of Physical Medicine and Rehabilitation.

It used the medical charts of 288 patients between the ages of 20 and 95 who were hospitalized for Covid-19 at the university hospital in March and April 2020. The analysis looked at discharge locations, therapy needs at the time of release, and the patients' need for durable medical equipment or other services.

About 68% of the patients required medical equipment such as a cane after being discharged from the hospital and about 27% who showed “functional changes” had difficulty swallowing at the time of release, Camero reports. In addition, about 40% were never assessed by a physical therapist, occupational therapist or speech language pathologist during their hospitalization.

“Physicians and others in the health-care system were working appropriately to discharge patients” in early in the pandemic, Daunter said on the blog. “So, the things we do in the hospital to maximize functioning, like mobility interventions and assessing activities of daily living, were not happening as often.”

These findings are just the tip of the iceberg when it comes to the effects of Covid on functioning, Anna Kratz, Ph.D., a clinical psychologist at Michigan Medicine and senior author of the paper, said on the blog post. 

“The major shifts in functioning that we highlight are important, but less dramatic declines in physical and cognitive functioning are likely to be found in nearly all previously hospitalized Covid patients,” said Kratz. “And we know from decades of rehabilitation work that even subtle changes in functioning can derail a person’s life trajectory. Future work needs to focus on improving our ability to identify and treat people across the full range of the functional decline spectrum.”