'Functionally 100%' of new coronavirus cases this month have been among the unvaccinated; back-to-work incentive offered

Washington Post chart, adapted by Kentucky Health News; for a larger version, click on it.

By Al Cross

Kentucky Health News

Making what they called the best argument for vaccination against the coronavirus, Gov. Andy Beshear and his health commissioner said Thursday that only 0.08 percent of recent virus cases in Kentucky are in people who have not received at least one dose of a Covid-19 vaccine.

At his weekly press conference, Beshear also announced a back-to-work incentive for Kentuckians getting extra unemployment benefits due to the pandemic, and a $763 million allocation of federal pandemic relief funds to child-care centers. Here are the details:

Vaccinations: Health Commissioner Steven Stack said 99.92% of the state's virus cases in the last four weeks, six out of 7,290, were in unvaccinated people. "That is functionally a hundred percent," he said. During the same period, unvaccinated people were 99 percent of those people hospitalized for Covid-19, and 93 percent of the deaths from the disease.

But only 49% of Kentucky's population has had at least one dose of vaccine, and just 42.5% are fully vaccinated, figures similar to states where the Delta variant of the virus is causing more hospitalizations.

"We've got to continue to talk about the vaccines," Beshear said. "The Delta variant's out there, and the threat is very real." He said the 99% figures presented by Stack "ought to be some of the best evidence for everybody who's qualified going out and getting vaccinated."

Stack said the variant, which originated in India and is expected to become dominant in the U.S., is more contagious than others, but only slightly more resistant to vaccines, which are 88% effective against death or severe disease from the variant.

"If you get vaccinated, you have essentially got a 90-percent-plus reduction in your risk for death and serious disease and going in the hospital," Stack said. "The new Delta variant is dangerous; it's more dangerous for younger people than the previous versions. We're gonna see more younger people get hurt. . . . Your risk is incredibly reduced if you get vaccinated." 

Stack noted that new coronavirus cases in Kentucky have declined for seven weeks in a row, much as new cases around the world have dropped for eight straight weeks, and said, "This is the result of vaccination, hands down, pure and simple. Vaccines did this."

State Dept. for Public Health graph, adapted by Ky. Health News; for a larger version, click on it.

Stack noted that the first of three drawings in the state's lottery-style sweepstakes for vaccinated people will be held next week, with the entry deadline Wednesday night. He said 472,938 adults had entered for a chance at $1 million, and 26,636 youth, ages 12-17, had entered for a full postsecondary-education scholarship, five of which will be awarded in each drawing.

He said those numbers create "way better odds" than the state lottery, and he hopes they inspire people to get a shot. "I hope, though, they're even more inspired by the fact that 100 percent of the people getting sick now in Kentucky are ones who are not vaccinated."

Vaccinations are lagging again; the seven-day average is below 10,000 a day. Beshear said signups for the drawings indicate that they have spurred vaccination, but it's hard if not impossible to tell how much. He said Ohio saw a boost when its drawings were announced, and when its first drawing was held.

Asked what the state might do about the possibility of the virus spreading from a free J.D. Shelburne concert Saturday in Spencer County, which has the state's second-lowest vaccination rate, Beshear said he was unaware of the event, but said the county's vaccinations may be under-reported due to ZIP code areas crossing county lines. Stack agreed, but said that even without the anomaly, the county would still have one of the lower vaccination rates.

Unemployment benefits: After weeks of requests from businesses and demands from Republicans, the Democratic governor said the state would give $1,500 each to the first 15,000 Kentuckians who are getting extra unemployment benefits of $300 a week and go back to work for four weeks. Critics have said the federally funded payments, which will expire Sept. 30, are keeping people from going back to work at a time when employers are having difficulty finding workers.

The governor said he has discussed the issue daily with business people, who he said have always thought a back-to-work payment would do more to get people back in the labor force than ending the payments, which some Republican governors have done. "This is meant to be surgical," he said. Details are at btw.ky.gov.

Beshear said the program will cost $22.5 million, which will come from funds the state has yet to spend from the Coronavirus Aid, Relief, and Economic Security (CARES) Act that Congress passed in bipartisan votes last year. He said the parameters were chosen to get one-fourth of those receiving the extra benefit back onto payrolls, and to equal five weeks of the extra benefit, which "gets you real close" to Sept. 30. He said he could still end the benefits before that date, based on his monitoring of the situation and the experience of other states.

Child care: The money for child care will come from the American Rescue Plan Act, passed with only Democratic votes. A state press release said $470 million will go to "sustainability payments" to child-care providers and $293 million will be used to increase provider payments, improve payment policies, raise wages for early-childhood educators and family child-care homes; and increase "the number of quality child care options for under-served populations."

Cabinet for Health and Family Services Secretary Eric Friedlander said the state will leave the pandemic with more small family providers of child care than it had going in, "so it is possible to work together to get a better spot. . . . I am so happy, and the child-care providers are so happy, that we now understand how important they are. They are vital to all of us getting back to work."

Families can apply for assistance at kynect.ky.gov. Information is also available at local offices of the Department for Community Based Services, where applications are also accepted.

Daily numbers: All major measures of the pandemic in Kentucky continued to decline Thursday. The state reported 204 new cases of the virus, lowering the seven-day rolling average by 7, to 174. The share of Kentuckians testing positive over the last seven days is 1.85%, the lowest on record, and the daily new-case rate over the last seven days is 3.22 per 100,000 residents.

Counties with rates more than double the statewide rate are Bracken, 20.6; Caldwell, 17.9; Hopkins, 16; Webster, 13.2; Graves, 10; Anderson, 9.4; Letcher, 8.6; Simpson, 8.5; Gallatin, 8.1; Morgan, 7.5; Carter, 7.5; Leslie, 7.2; Casey, 7.1; Greenup, 6.9; and Pike, 6.7.

The state recorded four Covid-19 deaths Thursday, bringing Kentucky's toll to 7,200. Deaths have been in single digits for the last 13 days, and no more than four have been reported for the last nine days. Deaths are averaging 3.14 per day over the last seven says and 4.43 a day over the last 14 days. The state has stopped listing individual deaths.

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Agriculture Secretary Tom Vilsack talks at Rural Health Journalism Workshop about boosting federal nutrition programs

By Melissa Patrick
Kentucky Health News

The Department of Agriculture is making sure children have enough to eat this summer, updating temporary food-assistance programs and evaluating federal formulas for food assistance, Agriculture Secretary Tom Vilsack told a rural health journalism workshop Wednesday.

Vilsack said he hopes the one-year Summer Food Service Program, also called the Summer Electronic Benefit Transfer Program, put in place because of the pandemic, will be continued permanently through the Biden administration's $1.8 trillion American Families Plan pending in Congress.

"We know these nutrition programs do make a difference in terms of health and educational outcomes," said the former Iowa governor in his second stint as secretary. "And so it's important for us to look at ways in which we can fill the gap between the 180 days of the school year and the summer months." 

$45 billion in the plan would extend what is called community eligibility, which determines whether a school district is qualified for free and reduced lunch, Vilsack said. During the pandemic, all schools have had access to free meals. 

He said that for the first time in 45 years, USDA is looking at the calculations used to determine benefits in the Supplemental Nutrition Assistance Program, formerly known as food stamps, because "There are significant gaps and barriers to accessing full and complete food security."

Kentucky had 603,105 people enrolled in SNAP, or 13.5% of the state's population, in May, according to the Kentucky Center for Economic Policy SNAP data tracker.

USDA graphic; for a larger version, click on it.

A USDA study issued the same day, Barriers that Constrain the Adequacy of Supplemental Nutrition Assistance Program Allotments, found that nearly nine out of 10 SNAP participants face barriers to providing their households a healthy diet for a full month.

The most common barrier, faced by 61% of households, was the cost of heathy food. Other barriers included a lack of time to prepare meals made from scratch (30%), the need for transportation to the grocery (19%) and no storage for fresh or cooked foods (14%), a USDA press release said.

Vilsack also spoke to the importance of continuing things that worked during the pandemic, such as the food-box program, encouraging producers to donate food, and ensuring that food banks have appropriate infrastructure to store their goods. USDA recently committed $1 billion toward this effort. 

Vilsack noted at the workshop, sponsored by the Association of Health Care Journalists, that Congress will make the decisions on such changes ad the "onus is on us" to make the case for them. 

"We know from studies that SNAP does reduce poverty. We know that it does improve health outcomes. We know that it reduces obesity rates among children of low income families. We know that it provides a better opportunity for these youngsters to be better learners, which results in higher graduation rates," he said. "So I think there's a return on investment that we need to remind Congress about so that as they look at the additional costs associated with these nutrition assistance programs, they understand we're getting significant benefit in reduced healthcare costs over time, in better educational outcomes and better employment opportunities for these youngsters." He added that SNAP benefits farmers and local rural economies.

Vilsack also hit on several other topics at the workshop, including issues around climate change, rural hospitals, and meat industry safety standards.

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Risks of vaccines are very small, but one in four Kentucky adults think those risks outweigh the benefits of getting vaccinated

Foundation for a Healthy Kentucky poll, Feb. 11-March 12, 2021; error margin +/-3.5 percentage points

By Melissa Patrick
Kentucky Health News

One in four Kentucky adults told pollsters last winter that the benefits of vaccines for adults are outweighed by the risks of taking them. That poses an obstacle to getting the state protected from stronger variants of the coronavirus, and raising the risks that other diseases may spread.

The poll was taken for the Foundation for Healthy Kentucky Feb. 11 through March 12, when vaccines for the virus were becoming widely available. It did not ask about those vaccines, but about vaccines generally.

Sixty-nine percent of adults said the benefits of vaccines for adults outweigh the risks of vaccine side effects, while 26% said the risks outweigh the benefits. On vaccines for children, 77% said the benefits outweigh the risks while 18% said the risks outweigh the benefits.

"I think this is a big issue, because it's been pretty clearly proved by science across the board that vaccines are not only safe, but are crucial to the health and well-being of our citizens and our society," Foundation President and CEO Ben Chandler told reporters Tuesday.

"What we've got, essentially, is a quarter of the entire population here in Kentucky who, I would interpret, believes that the vaccines, all vaccines, are essentially dangerous, and they're concerned about taking them. . . . So we got some educating to do." 

The poll indicated that most Kentuckians have plenty of information about the pros and cons of vaccines. When asked if they had heard about the advantages and disadvantages of vaccines for both adults and children, 84% for adults and 80% for children said they had heard either a "great deal" or a "fair amount" of information on the topic.

But they may not be getting the right information, Chandler said: "We've got a problem with the internet, with the dissemination of information throughout the society." He encouraged Kentuckians to seek information from their health-care providers and the Centers for Disease Control and Prevention, which he called "the best source that we've got." 

Asked if he thought the poll findings about vaccines in general were driven by discussions about the coronavirus vaccines, Chandler said that's possible. "But the health concerns go beyond Covid," he said. "If the vaccine controversies that have taken place cause people to not get their regular vaccines in the years ahead, we are going to be dealing with some serious health problems across the board here in Kentucky, and probably across the country." 

Washington Post charts, adapted by KHN; click on them to enlarge.

Chandler spoke out as vaccine uptake in the state is waning again, and public-health officials continue to work to get 70% of the state's population vaccinated, the level needed to reach herd immunity.

The latest CDC figures, as reported by The Washington Post, say Kentucky's seven-day average is 12,207 per day, down from an average of 18,369 on June 18. The latest daily figure, subject to revision, was 5,347. 

The CDC says more than 2.1 million Kentuckians have received at least one dose of a vaccine. That's 48.4% of the state's population; 42.3% are fully vaccinated. Full-vaccination rates range from 19% in Spencer County to 58% in Franklin County. 

Polls on vaccines have found major differences among political parties. In the foundation's poll, 82% of Democrats said the benefits of vaccines outweigh the potential risk for adults; that was true of 68% of independents and 59% of Republicans. 

When asked about children's vaccines, the results were closer, with 82% of Democrats, 80% of independents and 73% of Republicans saying the benefits of vaccines outweigh the potential risks.  

Chandler, a former Democratic attorney general and congressman, summed up polling on the issue:
"People in rural Kentucky, people with lower educational levels, white men, typically Republicans, are more hesitant and more concerned about the efficacy, not only of the Covid vaccine, but of all vaccines."

The foundation's annual health policy forum, to be held Sept. 20, will focus on vaccines. 

The poll, conducted by the Institute for Policy Research at the University of Cincinnati,  included more than 800 adults who were contacted by both landline and cellphones. Its margin of error is plus or minus 3.5 percentage points for each result.

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Ky. is reporting fewer than 200 new coronavirus cases per day, and the share of residents testing positive has fallen below 2%

State Dept. for Public Health map, adapted by Ky. Health News; click on it to enlarge.

By Al Cross

Kentucky Health News

Leading indicators of the pandemic in Kentucky have passed more milestones on a steady downward trend, but new daily vaccinations against the coronavirus are also declining, after a two-week rise.

The seven-day rolling average of new coronavirus cases dropped below 200 Saturday for the first time in almost a year, and stands at 196. At the height of the pandemic, in early January, the figure was over 4,000 a day.

The share of Kentuckians testing positive for the virus in the last seven days fell below 2 percent Saturday, to 1.98%. It grew to 2.01% Sunday but fell Monday to 1.95%, the lowest on record. At its height, on Jan. 10, it was 12.45%.

The state no longer issues daily reports on weekends, catching up on Mondays.

The rate of daily new cases over the last seven days continued its recent decline, falling to 3.4 per 100,000 residents. Counties with rates double or more the statewide rate were Bracken, 20.6; Webster, 18.8; Hopkins, 16; Elliott, 15.2; Graves, 11.5; Perry, 10.5; Whitley, 9.1; Breathitt, 9; Carter. 8; Letcher, 8; Owen, 7.9; Simpson, 7.7; Greenup, 7.3; Fleming, 6.9; and Robertson, 6.8.

For the last two days, Kentucky hospitals have reported 202 Covid-19 patients, the fewest since early in the pandemic; the earliest state report of hospitalizations, on April 28, 2020, said there were at least 320.

The number of Covid-19 patients in intensive care has been falling for four weeks, and is now 48, with 28 on a ventilator, says the state's daily report.

Deaths have also declined, and are averaging 3.9 per day for the last seven days and 6.2 per day for the last 14 days. The state's Covid-19 death toll stands at 7,190.

Vaccinations against the virus have generally declined in the last few days, after generally rising for almost two weeks. The latest Centers for Disease Control and Prevention figures, as reported by The Washington Post, say Kentucky's seven-day average is 12,899 per day, down from an average of 18,369 on June 18. The latest figure is subject to revision.

Washington Post chart, adapted by Ky. Health News; click here for the interactive version.

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Kentucky still ranks 37th in well-being of children in latest Kids Count Data Book, but not progressing as much as other states

By Melissa Patrick

Kentucky Health News

The annual Kids Count Data Book on children's well-being, released June 21 by the Annie E. Casey Foundation and Kentucky Youth Advocates, again ranks Kentucky 37th in the nation for the overall well-being of its children. 

The latest data are for 2019, and are largely compared with data from 2010. The report rates children's overall well-being through 16 indicators in four major domains: health, economic security, education and family and community. 

Overall, Kentucky saw improvement in 11 of the 16 indicators, did worse in three of them and stayed the same on one. One measure did not show a comparison. 

“Though the commonwealth made progress on a number of indicators of child well-being between 2010 and 2019, rankings show we are not making progress as quickly as other states – and that progress is in jeopardy unless federal and state policymakers act boldly to sustain the beginnings of pandemic recovery efforts,” Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. 

Nearly one in four Kentuckians are children. Here's a look at each domain.

Charts from Kids Count Data Book; to enlarge any one of them, click on it.

Health: Kentucky's health ranking improved this year, to 35th. Last year's report ranked Kentucky 42nd after changing one of the domain's indicators to measure childhood obesity instead of youth alcohol and drug abuse. The last report to use the original indicator was in 2019, when the state ranked 25th for health. 

The report says 37 percent of Kentucky's children were either overweight or obese in 2018-19, the same as in 2016-17. The national rate is 31%. Kentucky has the highest childhood obesity rate in the nation. 

Kentucky continues to have a low rate of children without health insurance, 4%. The national average is 6%. The news release reports that about  45,000 Kentucky children remain uninsured.

Another indicator of children's health is the rate of babies born weighing less than 5.5 pounds. That is 8.7% in Kentucky, where it has hovered for years. 

Education: Kentucky ranked 30th in Education category, down from 27th last year. 

The best news in this domain is that 91% of Kentucky high-school students graduate on time. 

The bad news is that the number of preschool-aged children not in school increased to 60% in 2017-19, from 57% in 2009-11. And the percentage of fourth-graders not proficient in reading inched up to 65% in 2019, from 64% in 2009. 

And though the percentage of eighth graders who are not proficient in mathematics improved to 71% in 2019, from 73% in 2009, that still means only 29% of the state's eight-graders are proficient in math. 

Economic well-being: Kentucky ranks 40th in economic well-being, with all four indicators showing improvement since 2010. 

The percentage of Kentucky children in poverty dropped to 22% in 2019, from 26% in 2010; children whose parents lack secure employment dropped to 31% from 37%; and teens who are not in school and not working dropped to 8% from 11%. 

Also, the percentage of children living in households with a high housing cost burden dropped to 23% in 2019 from 32% in 2010.  A high housing-cost household is defined as one where more than 30% of monthly household pre-tax income is spent on housing-related expenses, including rent, mortgage payments, taxes and insurance.

Family and Community: Kentucky ranked 43rd in the family and community domain, down from 41st in last year's report. 

Kentucky improved in three family-and-community indicators, including children living in high-poverty areas (15%), children living in families where the household head lacks a high school diploma (11%) and teen births.

The number of teen births in Kentucky continues to drop. In 2019, there were 25 births per 1,000 females aged 15-19. In 2010, that number was 46 per 1,000. The national average is 17 per 1,000. 

The percentage of children living in single-parent homes increased to 36% in 2019, from 35% in 2010. 

Impacts from the pandemic

"We cannot talk about child well-being in any meaningful way in this moment — or address the considerable challenges America’s children and families now face — without discussing the effects of the coronavirus," Lisa M. Hamilton, president and CEO of The Annie E. Casey Foundation, writes in the foreword to the report. 

To capture the impact of the last year, the Data Book takes a look at information collected in the Household Pulse Survey, which the report says was conducted in multiple waves since the onset of the pandemic by the Census Bureau and is the only source of robust national and state data related to the pandemic. 

“The supplemental pandemic-era survey data highlighted in the Data Book gives us a clearer picture of how families are faring today, including the disproportionate impact the pandemic has had on families of color," said Brooks. 

Key findings about Kentucky children in the supplemental report include: 

• In 2020, one in five (20%) Kentucky adults with children in their household had little or no confidence in their ability to make their next rent or mortgage payment, with the highest rates experienced by Black families (40%) and Latinx families (30%). By March 2021, the statewide rate was at 15%, suggesting the beginnings of a recovery. 
• 15% of Kentucky households with children reported sometimes or often not having enough food to eat throughout 2020 – a family stressor that hit Black households (26%) and a combination of smaller racial groups (American Indian, Alaska Native, Pacific Islander, Native Hawaiian and those of more than one race) the hardest (29%). This statistic only slightly improved overall in March 2021 to 13%.
• More than one in four (26%) Kentucky adults living in households with children felt down, depressed, or hopeless in 2020, with only slight improvement (22%) by March 2021.

Brooks, of Kentucky Youth Advocates, said, “The commonwealth can and will bounce back from the ripple effects of the pandemic, and a key component of that is ensuring kids and families have the resources to meet basic needs and overcome daily challenges.”

Brooks praised the state's leaders for supporting children during the pandemic, by supporting child care, using federal funds to address the pervasive "digital divide," and ensuring schoolchildren have access to food while learning at home through the pandemic EBT program. 

KYA wants Congress to make the expansion of the child tax credit permanent, and wants Kentucky to enact its own refundable earned-income tax credit; to focus on increasing access to high-quality child care; to use federal funds to improve school-based mental-health supports for students; to expand school-based nutrition programs; to allow state employees 12 weeks of paid family leave after the birth or adoption of a child; and to double down on efforts to support families involved in the child welfare system. 

The Kids Count Data Center provides current and trend data for child well-being indicators related to each of the four domains in the report, at both a state and county level. It also offers a feature to create customized tables, maps, bar charts and graphs.

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Temporary Medicaid ending; special marketplace enrollment period ends Aug. 15; premium-free COBRA ends in September

FamiliesUSA graphic

By Melissa Patrick

Kentucky Health News

Kentuckians have about two more months to buy reduced-cost health insurance on the federal marketplace under the special enrollment period. The deadline to sign up on healthcare.gov is Aug. 15. 

The Biden administration reopened the marketplace in mid-February under the American Rescue Plan Act, for people who needed coverage during the pandemic, and later extended the deadline to Aug. 15. 

The special enrollment is open to both new and existing customers, including the thousands of Kentuckians who qualified for temporary Medicaid coverage during the pandemic through the state's "presumptive eligibility" program. The PE program will end for some of them on June 30.

"Kentuckians who will be losing their PE coverage at the end of this month, should contact a kynector to learn more about regular Medicaid and Marketplace options," Kentucky Voices for Health said June 15. 

KVH said Kentuckians who have been enrolled in PE coverage since January will be disenrolled on June 30. Those who enrolled after January may have a different end of coverage date.  

The special enrollment period includes provisions that make the plans more affordable, including enhanced premium subsidies, also known as tax credits, to help offset the cost of insurance. It also makes more people eligible for the subsidies, limits costs to no more than 8.5% of income, down from nearly 10%, and eliminates repayments that may be required when people reconcile their tax return with the tax credit they received. 

“Four of five enrollees will be able to find a plan for $10 or less per month after premium tax credits, and over half will be able to find a Silver plan with a zero-dollar premium," Carrie Banahan, deputy secretary of the state Cabinet for Health and Family Services, said in a news release. 

Silver plans have the the second-lowest costs and are the benchmarks used to calculate the tax credits. They are the most common choice of marketplace shoppers, said Banahan.

State officials said premiums will decrease on average by $50 per person per month, or by $85 per policy per month, although the savings will vary per individual. 

Through the end of May, just over 10,000 Kentuckians signed up for health insurance during the special enrollment period, according to a federal report. 

That's an increase in enrollment from the same period in 2020 and 2019, when 5,550 and 5,789 signed up, respectively. Open enrollment is usually in effect only six weeks at the end of a year, except for those who experience a "qualifying life event," like getting married or losing a job.

Nationwide, more than 1.2 million people have signed up. 

New premium-free COBRA options until September

If you had health insurance through your job until you lost hours or lost employment, you and your family may qualify for health coverage through premium-free COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, which instituted the provision). 

The American Rescue Plan also requires the federal government to pay 100% of COBRA insurance premiums for eligible employees who lose their jobs (and for their covered relatives) through September, allowing them to stay on their company-sponsored health plans.

Families USA offers a fact sheet that answers a variety of questions about eligibility, enrollment process and other topics. It also features a list of local, state and national resources. 

Families USA also warns consumers that COBRA is only available through their former employer or health plan, and not through a website. 

President Biden has proposed in his American Families Plan to make some of these pandemic changes permanent, including the premium tax credits, expanded coverage to those who earn 400% and above the federal poverty level, and the 8.5% household income cap on the monthly amount a person would pay for their policy.

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Kentucky ranks low in vaccinations of nursing-home employees

Centers for Medicare and Medicaid Services graph, adapted by Ky. Health News; click it to enlarge

Employees providing care at Kentucky nursing homes are among the least likely in the country to be vaccinated against the coronavirus, which has killed almost 2,500 people in those nursing homes.

The extent of the problem could be worse, because only about a third of the state's nursing homes have reported vaccination figures to the Centers for Medicare and Medicaid Services, which pays most of their costs and regulates them.

The latest update of the database, June 17, showed that 45.09 percent of the health-care employees at reporting nursing homes had been fully vaccinated for the virus. That was ninth lowest among the states.

Sherry Culp, state government's long-term-care ombudsman, told the Lexington Herald-Leader, “My concern is that having staff who are not vaccinated coming into these places every day and working in close proximity with residents could increase the incidence of Covid once again.”

Culp noted that 78% of nursing-home residents are fully vaccinated, and Herald-Leader reporter John Cheves notes that the homes had only 13 active cases in Wednesday. But he notes, "The state already saw one tragedy this year," at a nursing home in Morehead, "when an unvaccinated worker brought in the virus and infected 46 people. Three people died, including a vaccinated resident."

A study of the outbreak found that it was caused by a mutated variant of the virus. Health experts warn that unvaccinated people are breeding grounds for more variants, which can be more contagious and/or more deadly. Current vaccines seem largely effective, but the Delta variant that is 6 to 10 percent of U.S. cases and is expected to become dominant requires two doses of vaccine to be suppressed. One dose is only 33% effective, research indicates.

Nursing homes say they don't want to require vaccination, for fear of losing employees at a time when the workforce is tight. They also cite "skepticism about the safety and effectiveness of the vaccine, particularly for women of child-bearing age" and the belief that they are immune to the virus because they have been exposed to it, "an assumption that is not always accurate," Cheves writes.

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the state nursing-home trade group, told Cheves, “The most successful strategies that we have seen are personal discussions with mentors, colleagues and experts to dispel fears and mistruths. Businesses are choosing to use approaches that are friendly and less forceful to manage those who are reluctant of the government. We continue to push vaccine efforts and are hopeful to see an increase among our front-line workers.”

At Cumberland Valley Manor in Burkesville, where only 23% of health-care workers are fully vaccinated, Administrator Mary Beth Shelton told Cheves, “We’re giving them the facts, we’re giving them the statistics. I’ve personally had the vaccine and I’ve had no side effects, and I talk about that.”

Shelton said the reason she hears most from employees for not getting vaccinated “is that it’s new on the market and it’s not FDA-approved yet, so they have doubts about it.” The Food and Drug Administration has approved three vaccines for emergency use and is expected to give at least one full approval this fall.

Most nursing homes are owned by chains. "Culp says she has spoken to Kentucky nursing home administrators who are privately advising their facilities’ corporate owners to consider making vaccination mandatory for employees, Cheves reports, and a federal judge in Texas has ruled that they can.

But in rural places like Burkesville, requiring vaccination is not practical, Shelton told Cheves: “I would hate to lose anybody because of that. The reality of the situation is that it’s just not doable in our setting, especially in rural areas where we fight for staff. It’s just not possible for us.”

One thing nursing homes will feel compelled to do, starting June 20, is report their vaccination data. On that date, CMS says “Failure to meet these new reporting requirements will result in a [penalty] starting at $1,000 for facilities with no previous occurrences of noncompliance.”

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