Thursday, January 27, 2022
Covid-19 can cause psychological problems; UK case is an example, and also of surgery that can prevent epileptic seizures
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| From left: Sally Mathias, M.D.; Aleina Milligan; her sister Kelly Milligan, the patient; Farhan Mirza, M.D., and Timothy Ainger, Ph.D. (University of Kentucky photo by Pete Comparoni) |
University of Kentucky
Aleina and Kelly Milligan of Columbia are more than sisters; they are truly best friends. For Kelly, her older sister has been a lifeline during the past two years.
“I was so excited when she decided she wanted to move down here because I thought, ‘This is awesome! I’m going to get to have my sister,’” Aleina said. “And then she got so sick.”
Kelly has dealt with seizures her entire life. She lived and worked in a sheltered employment program in Michigan and had worked as a custodian for 29 years. After experiencing some health issues while at work and after their mother passed away, Kelly decided to move in with her sister.
“She had no support system in Michigan, and it was just too much,” said Aleina.
But Aleina became concerned when she noticed a change in Kelly’s seizure patterns, so they came to see UK HealthCare’s Dr. Sally Mathias, an assistant professor of neurology who specializes in epilepsy.
“When I first saw her, I knew we needed to know more,” Mathias recalled. “She had never had some of the basic testing that is required for epilepsy, so we started off with that.”
The fact that Kelly’s seizure patterns had changed stood out to the epilepsy specialist, but that wasn’t all. “What is very rare is that her heart was actually stopping with every seizure — it is called ‘ictal bradycardia’,” said Mathias. “We noticed that on the Epilepsy Monitoring Unit. The longest her heart stopped while she was in our hospital was 20 seconds.”
To explore this further, they sent her home with a heart monitor for a few weeks. While at home, the heart monitor detected 30 seconds when Kelly’s heart had stopped.
“This was very serious and needed immediate attention,” said Mathias. “We directly admitted her to cardiology, and she got a pacemaker.”
Kelly was shocked to learn about what was happening with her body. This was all new for Aleina, but as they learned, she more says it did start to make sense.
“I was with her several times and experienced when she would just drop,” Aleina said. “There was one time I kept looking at her and thought ‘She is not breathing … surely not though, she must be breathing.’ After we found this out, I’m like, ‘OK, she wasn’t breathing.’ We are very fortunate that nothing has happened, and her heart continued to restart.”
After receiving her pacemaker, the next step for Kelly was epilepsy surgery, something she had never considered before meeting the doctors at UK HealthCare.
“It still baffles me that no one ever did basic testing for epilepsy on her, and that when I discussed epilepsy surgery with them, it was the first time they had heard of it,” said Mathias.
In August 2020, Dr. Farhan Mirza, assistant professor of neurosurgery and director of epilepsy surgery, successfully did surgery on Kelly’s brain. For the first time, she or her sister can remember, Kelly was seizure-free.
“We could go places and not have to go through the thought process of ‘What if?’” said Aleina. “For example, I had been thinking it would be wonderful to visit the beach and go swimming, but I was always afraid to get her in the water, because, what if she dropped?”
Mirza said, “Kelly's journey, like so many of our patients with refractory epilepsy, highlights two important things: No one should have to suffer from uncontrolled epilepsy for decades, and all patients who are resistant to anti-epileptic medications deserve to be evaluated for possible surgical options in a timely fashion. This can be done effectively only at highly specialized centers like UK where we offer advanced multi-disciplinary care for refractory epilepsy.”
The sisters were thrilled to have a greatly improved quality of life as Kelly celebrated her 50th birthday complete with a crown and a sash, less than two months after her epilepsy surgery.
“She was not limited anymore, and that is fantastic,” said Aleina.
Second chapter: Just weeks after celebrating her 50th birthday, two and a half months after her brain surgery, Kelly contracted Covid-19. She started showing symptoms about a week after Aleina came down with the virus. As Aleina recovered, Kelly’s symptoms worsened.
“She started telling me that she was having these strange neurological symptoms – tingling, burning, rushing feelings in her hands and feet, and continuous thoughts that she could not control,” said Aleina. “Kelly had never had any mental problems other than minor anxiety.”
After a few months of feeling like they could finally enjoy life together, Aleina was again reaching out to doctors with great concern for her sister.
“I read some articles about studies looking at the possibility that Covid can attack the weakest part of a person,” said Aleina. “I just assumed that would be her brain because she just had this major surgery.”
At that point, Covid-19 was still relatively new. Aleina says the doctors she spoke with did not know much about the virus other than to tell her that if Kelly’s breathing was okay, then she was okay.
“She continued to get worse … her brain, the tingling,” said Aleina. “It never presented in her lungs, but she just kept acting more strangely. She would say she was on fire and that she felt there was something evil after her.”
Kelly does not remember much of that time, and Aleina says that's a good thing. After about 10 days, Aleina took her to their local emergency department because she was afraid her sister was having another seizure. She wasn’t, though she had a fever and a low level of sodium.
The sisters continued to live like this for several more days and found themselves in the midst of the holiday season. Kelly continued to have a growing feeling that something was invading her body and mind. She then ended up back in the hospital with pancreatitis, which doctors attributed to her Covid-19 infection. Then just a few days after Christmas, Kelly tried to harm herself, and she was admitted to Eastern State Hospital.
“She was in full-blown psychosis,” said Aleina. “She was hallucinating and thought she was being told to harm herself or us.”
Her neurology doctors “were very concerned for her, but at that time there really were not any reports of COVID harming anybody mentally,” Aleina said. “They just didn’t know if it could be related.”
After three weeks at Eastern State, Kelly returned home on some medication that helped a little while, but quickly took a turn for the worse.
“She had gotten so bad … she was no longer my sister,” Aleina said. “It was horrible.”
Kelly was not eating. She would not communicate. Then, she began abusing her medications.
“I got ahold of Dr. Mirza and Dr. Mathias, and I was very honest with them and begged them to get her in for an appointment,” said Aleina. “I said, ‘I don’t know what is going on, but something is wrong, and she is going to die if we do not figure this out.’”
Drs. Mirza and Mathias, and neuropsychologist Timothy Ainger met with Kelly and decided that she couldn’t be sent back home. They knew right away that something was not right because she had undergone a neurocognitive evaluation as part of her pre-surgical workup, and the new results were much different.
Aleina and Kelly Milligan of Columbia are more than sisters; they are truly best friends. For Kelly, her older sister has been a lifeline during the past two years.
“I was so excited when she decided she wanted to move down here because I thought, ‘This is awesome! I’m going to get to have my sister,’” Aleina said. “And then she got so sick.”
Kelly has dealt with seizures her entire life. She lived and worked in a sheltered employment program in Michigan and had worked as a custodian for 29 years. After experiencing some health issues while at work and after their mother passed away, Kelly decided to move in with her sister.
“She had no support system in Michigan, and it was just too much,” said Aleina.
But Aleina became concerned when she noticed a change in Kelly’s seizure patterns, so they came to see UK HealthCare’s Dr. Sally Mathias, an assistant professor of neurology who specializes in epilepsy.
“When I first saw her, I knew we needed to know more,” Mathias recalled. “She had never had some of the basic testing that is required for epilepsy, so we started off with that.”
The fact that Kelly’s seizure patterns had changed stood out to the epilepsy specialist, but that wasn’t all. “What is very rare is that her heart was actually stopping with every seizure — it is called ‘ictal bradycardia’,” said Mathias. “We noticed that on the Epilepsy Monitoring Unit. The longest her heart stopped while she was in our hospital was 20 seconds.”
To explore this further, they sent her home with a heart monitor for a few weeks. While at home, the heart monitor detected 30 seconds when Kelly’s heart had stopped.
“This was very serious and needed immediate attention,” said Mathias. “We directly admitted her to cardiology, and she got a pacemaker.”
Kelly was shocked to learn about what was happening with her body. This was all new for Aleina, but as they learned, she more says it did start to make sense.
“I was with her several times and experienced when she would just drop,” Aleina said. “There was one time I kept looking at her and thought ‘She is not breathing … surely not though, she must be breathing.’ After we found this out, I’m like, ‘OK, she wasn’t breathing.’ We are very fortunate that nothing has happened, and her heart continued to restart.”
After receiving her pacemaker, the next step for Kelly was epilepsy surgery, something she had never considered before meeting the doctors at UK HealthCare.
“It still baffles me that no one ever did basic testing for epilepsy on her, and that when I discussed epilepsy surgery with them, it was the first time they had heard of it,” said Mathias.
In August 2020, Dr. Farhan Mirza, assistant professor of neurosurgery and director of epilepsy surgery, successfully did surgery on Kelly’s brain. For the first time, she or her sister can remember, Kelly was seizure-free.
“We could go places and not have to go through the thought process of ‘What if?’” said Aleina. “For example, I had been thinking it would be wonderful to visit the beach and go swimming, but I was always afraid to get her in the water, because, what if she dropped?”
Mirza said, “Kelly's journey, like so many of our patients with refractory epilepsy, highlights two important things: No one should have to suffer from uncontrolled epilepsy for decades, and all patients who are resistant to anti-epileptic medications deserve to be evaluated for possible surgical options in a timely fashion. This can be done effectively only at highly specialized centers like UK where we offer advanced multi-disciplinary care for refractory epilepsy.”
The sisters were thrilled to have a greatly improved quality of life as Kelly celebrated her 50th birthday complete with a crown and a sash, less than two months after her epilepsy surgery.
“She was not limited anymore, and that is fantastic,” said Aleina.
Second chapter: Just weeks after celebrating her 50th birthday, two and a half months after her brain surgery, Kelly contracted Covid-19. She started showing symptoms about a week after Aleina came down with the virus. As Aleina recovered, Kelly’s symptoms worsened.
“She started telling me that she was having these strange neurological symptoms – tingling, burning, rushing feelings in her hands and feet, and continuous thoughts that she could not control,” said Aleina. “Kelly had never had any mental problems other than minor anxiety.”
After a few months of feeling like they could finally enjoy life together, Aleina was again reaching out to doctors with great concern for her sister.
“I read some articles about studies looking at the possibility that Covid can attack the weakest part of a person,” said Aleina. “I just assumed that would be her brain because she just had this major surgery.”
At that point, Covid-19 was still relatively new. Aleina says the doctors she spoke with did not know much about the virus other than to tell her that if Kelly’s breathing was okay, then she was okay.
“She continued to get worse … her brain, the tingling,” said Aleina. “It never presented in her lungs, but she just kept acting more strangely. She would say she was on fire and that she felt there was something evil after her.”
Kelly does not remember much of that time, and Aleina says that's a good thing. After about 10 days, Aleina took her to their local emergency department because she was afraid her sister was having another seizure. She wasn’t, though she had a fever and a low level of sodium.
The sisters continued to live like this for several more days and found themselves in the midst of the holiday season. Kelly continued to have a growing feeling that something was invading her body and mind. She then ended up back in the hospital with pancreatitis, which doctors attributed to her Covid-19 infection. Then just a few days after Christmas, Kelly tried to harm herself, and she was admitted to Eastern State Hospital.
“She was in full-blown psychosis,” said Aleina. “She was hallucinating and thought she was being told to harm herself or us.”
Her neurology doctors “were very concerned for her, but at that time there really were not any reports of COVID harming anybody mentally,” Aleina said. “They just didn’t know if it could be related.”
After three weeks at Eastern State, Kelly returned home on some medication that helped a little while, but quickly took a turn for the worse.
“She had gotten so bad … she was no longer my sister,” Aleina said. “It was horrible.”
Kelly was not eating. She would not communicate. Then, she began abusing her medications.
“I got ahold of Dr. Mirza and Dr. Mathias, and I was very honest with them and begged them to get her in for an appointment,” said Aleina. “I said, ‘I don’t know what is going on, but something is wrong, and she is going to die if we do not figure this out.’”
Drs. Mirza and Mathias, and neuropsychologist Timothy Ainger met with Kelly and decided that she couldn’t be sent back home. They knew right away that something was not right because she had undergone a neurocognitive evaluation as part of her pre-surgical workup, and the new results were much different.
“It is a very comprehensive evaluation of your cognitive abilities and how well your mind is functioning,” Ainger said. “She had gone from being talkative, engaged, and polite to being terrified, psychotic, and reserved.”
Her epilepsy doctors, Mirza and Mathias, had seen this surgery done successfully on so many patients and knew that this reaction was not typical. Mathias recalled, “We were naturally thinking, ‘Okay, what else is going on?’”
They said they felt good about Kelly’s surgery, but also knew that these issues occurred not long after it.
“She was doing great from a procedure perspective and didn’t have any issues,” said Mathias. “After surgery, some issues can develop. So that is what we were thinking … Maybe it wasn’t entirely because of the surgery … but I did have that in the back of my mind, because I can’t exclude that.”
The doctors also said operating on that area of Kelly’s brain wasn’t a likely cause for the type of psychiatric symptoms she was having. When Ainger looked through Kelly’s medical notes and history, he discovered the culprit.
“It then became very obvious,” Ainger said. “Right after she had just come out of the acute Covid illness, she had this rapid and sudden onset of symptomology. It was very similar to what the literature has been suggesting in the few cases that existed and very similar in one or two other patients that we had treated.”
They treated Kelly's case as some form of Covid-induced encephalitis, swelling of the brain, starting immunoglobulin therapy and changing one of her seizure medications.
“Within one week, my sister was back,” Aleina recalled. “She was still medicated with the anti-psychotic medication, but she was Kelly again.”
Since then, Aleina says they have been able to back Kelly off from 20 milligrams of her antipsychotic medication to one milligram.
“We completely believe we are going to be able to have her off that completely very soon,” Aleina said. “She is doing great. It has been a real journey.”
In the course of a year, Kelly has been on a roller coaster with her health: a dramatic brain surgery to rectify seizures, a bout of ovid-19, the development of psychosis, and then - thanks to intervention - back to normal and seizure-free. Through all those ups and downs, she and her sister are thankful for the team at UK.
“Because of the way this team works together, it was not six months, nine months, or even 12 months of working with other hospitals and dealing with referrals,” said Ainger.”We were able to just walk into each other’s offices, have meetings, and get this managed right away. That is not the kind of service people get from hospitals that don’t have multidisciplinary teams like this.”
In this case, the teamwork even went outside of the neurology department – it also included cardiology, considering Kelly’s prior heart issues and pacemaker.
“This one was different and a lot of cross-functional teamwork, but we do this for every patient,” said Mathias. “We come together to help our patients especially when they are going through such difficult times.”
Thanks to their teamwork and dedication, Kelly and Aleina are now finally getting to enjoy living in the same place.
“I’ve got her back and so now we can grow old together,” said Aleina. “I’m kind of already there, but we are so looking forward to it.”
“Kelly's story is truly one of years of anguish, a glimpse of seizure freedom, a calamitous decline, followed by a complete recovery,” said Mirza. “We are thrilled to see her faring so well and are honored to have been a part of Kelly and Aleina's inspirational journey.”
Wednesday, January 26, 2022
Virus infection rate stalls, but new-case average hits a new high and Covid-19 hospitalizations jump 4% in one day, nearing record
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| Regions in red are using over 80% of ICU beds. (State table, adapted by Ky. Health News; click to enlarge) |
Kentucky Health News
Covid-19 hospitalizations in Kentucky jumped 4 percent from Tuesday to Wednesday, to nearly 2,500, as the state seemed likely to set a new record this week for residents hospitalized with the disease.
The seven-day average of new coronavirus cases reached a new high, 12,462, as the state reported 12,827 new cases Wednesday. However, the state's infection rate dropped slightly, and now ranks 11th in the nation, rather than second, as it did Tuesday, according to The New York Times.
The percentage of Kentuckians testing positive for the virus in the last seven days also fell slightly; it is 32.44%, based on 185,522 laboratory tests. The figures do not include at-home tests.
Kentucky hospitals reported 2,497 patients with Covid-19 as of midnight. That was 96 more than 24 hours earlier, on of the biggest jumps ever, and just 44 short of the record 2,541 Covid-19 patients reported on Sept. 10.
However, a smaller share of patients with Covid-19 are in intensive-care units than during the late-summer surge. ICUs reported 474 Covid-19 patients, with 271 on mechanical ventilation; at the high point in September, ICU cases numbered 698, with 448 ventilated.
Hospitals have said they are discovering Covid-19 cases in some people who have been admitted for other reasons, but several hospitals are limiting or suspending elective surgeries that require an overnight stay, perhaps due more to staffing shortages than the increase in Covid-19 patients.
The state's daily report showed more ICU capacity than on most recent days, with only three of the 10 hospital readiness regions using more than 90% of their ICU beds. Another six were between 80% and 90%.
The state's seven-day coronavirus infection rate is 234.7 daily cases per 100,000 residents, slightly less than Tuesday's 235.9 but still not far from the record 237 set last Friday.
Counties with rates above 300 per 100,000 residents are Hopkins, 415.3; Muhlenberg, 404.5; McCracken, 396.1; Daviess, 363.5; Powell, 350.2; Henderson, 339.4; Harrison, 329.8; Boyd, 327.5; Whitley, 323.4; Hardin, 322.5; Harlan, 318.6; Spencer, 317.4; McLean, 311.9; Ohio, 311.4; Shelby, 308.9; and Henry, 308.3.
Jefferson County's rate is 240 per 100,000, just above the state average and Fayette County's rate is 248.8, but the Lexington-Fayette County Health Department reported 1,040 new cases Wednesday, the first time above 1,000. (The department's numbers differ from the state's, due to reporting methodologies.)
The state attributed 31 more deaths to Covid-19, raising Kentucky's pandemic toll to 12,817.
In other pandemic news:
- The Richmond city commission voted 3-2 Tuesday night to offer a $500 vaccination incentive to employees, using federal pandemic relief funds. The city is following the local examples of the Madison County school board and Eastern Kentucky University, reports Taylor Six of the Richmond Register.
- Mercer County schools are again requiring masks, due to an increase in coronavirus cases, Lexington's WKYT-TV reports. The county's seven-day infection rate is 279.4 per 100,000 residents.
Tuesday, January 25, 2022
7-day average for Covid-19 cases a record; Ky. rate is No. 2 in nation; surge causing more hospitals to limit elective procedures
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| NYT chart shows states with top 7-day rates of new coronavirus cases Tuesday; click on it to enlarge. |
By Melissa Patrick
Kentucky Health News
The Omicron variant of the coronavirus continues to surge in Kentucky, with Tuesday setting a record for the highest seven-day rolling average, and the acceleration of hospital cases is making some hospitals limit elective procedures.
Kentucky reported its second highest number of new coronavirus cases Tuesday, 15,305. That brings the the seven-day rolling average to 12,427, the highest yet and the first time that number has been above 12,000.
The seven-day infection rate is 235.88 daily cases per 100,000 residents, the second highest ever, exceeded only by 237.01 on Friday, Jan. 21. Three counties are above 400 cases per 100,000: Muhlenberg, Hopkins and McCracken. State officials consider any rate above 25 a high level of transmission.
Kentucky's rate has shot up to No. 2 among the states, behind only Kansas, according to The New York Times' ranking of states and territories.
Kentucky hospitals reported 2,397 Covid-19 patients, a 3.1% rise from Monday; the increase of 71 cases was one of the largest recent daily increases. Today's Covid-19 hospital census is only 5.7% short of the all-time high of 2,541, recorded Sept. 10.
Hospitals report that 452 Covid-19 patients are in intensive care, an increase of 12 from Monday, and 272 of them are on mechanical ventilation, up 15. The number of patients on mechanical ventilation is 60% of the intensive-care unit count, higher than usual, and the highest it's been since Oct. 13.
Nine of the state's 10 hospital regions continue to use at least 80% of their intensive-care capacity, with two above 90%.
The surge of hospital cases across the state is straining the system, causing some hospitals to stop non-urgent procedures. The latest report comes from Baptist Health Richmond, which will start restrictions Wednesday.
At a news conference Monday, Dr. Mark Dougherty, an infectious-disease specialist at Baptist Health Lexington, said his hospital started limiting elective procedures earlier this month, largely for those that require a hospital stay.
“We had a limited staff; we needed to prepare ourselves to take care of more Covid patients,” Dougherty said. “Now we’ve gone to limiting all elective procedures, and we’re making a decision on that on a week-by-week basis. . . . We're hoping that we'll be able to cease doing that in one to two weeks."
Dr. Dan Goulson, chief medical officer of CHI Saint Joseph Health said his hospital is looking at the need to stop elective procedures day-by-day.
"For the most part [we] have not had to restrict elective surgeries, though there certainly have been days where based on staff call-outs or other other crimps on the system that we've not been able to do a particular surgical case on the day that it was originally intended for," he said.
Dr. Ashley Montgomery-Yates, chief medical officer for inpatient and emergency services at UK HealthCare, said they have "not officially" limited elective surgeries during the surge, "but honestly, I'm not sure we also ever got all of our operating rooms back up and running full force, because we're so understaffed." Health Commissioner Steven Stack said Monday that Kentucky is "running out of health-care workers."
Dr. Dan Goulson, chief medical officer of CHI Saint Joseph Health said his hospital is looking at the need to stop elective procedures day-by-day.
"For the most part [we] have not had to restrict elective surgeries, though there certainly have been days where based on staff call-outs or other other crimps on the system that we've not been able to do a particular surgical case on the day that it was originally intended for," he said.
Health officials regularly urge more Kentuckians to get a Covid-19 vaccine and booster shot as a way to decrease hospitalizations, since most Covid-19 patients are unvaccinated and booster shots are needed to avoid substantial risk of severe illness and hospitalization.
The state said Monday that in Kentucky, 77.5% of coronavirus cases, 84.5% of Covid-19 hospitalizations and 83.1% of Covid-19 deaths from March 1 to Jan. 19 were in people partially vaccinated or unvaccinated.
The share of Kentuckians testing positive for the virus in the last seven days is 33%. Last Monday, this rate was 30.25%, but it has been on a near-plateau for three days. Today's figure is based on 187,652 laboratory tests and does not include the results of any at-home tests.
Of today's new cases, 22% are in people 18 and younger. Vaccination rates are lowest in that age group.
Health officials are also urging Kentuckians to upgrade their masks. Deborah Yetter of the Louisville Courier Journal reports that the Biden administration will ship free N95 masks to Kentucky this week and that they can be found at Meijer, CVS and Walgreens. "N95 and KN95 masks are considered to be the most effective against the highly contagious Covid-19 virus," she writes.
The state reported 23 more Covid-19 deaths Tuesday, bringing Kentucky's pandemic death toll to 12, 786.
Monday, January 24, 2022
Pandemic still set records but may be nearing its crest in Ky.; short-staffed hospitals struggle to keep up; better masks urged
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| State Dept. for Public Health graph, adapted by Ky. Health News; for a larger version, click on it. |
Kentucky Health News
As hope mounts that the Omicron-variant surge will soon crest in Kentucky, hospitals in the state remain strained and a workforce that is struggling to stay healthy, prompting Health Commissioner Steven Stack to say the state is not running out of beds and ventilators, "We're running out of health-care workers."
Kentucky has averaged 11,489 new cases of the coronavirus in the last seven days, less than the seven-day average reported last Friday, and lower than the record high seven-day average of 11,789 set Sunday.
Another sign that the surge may be cresting is a four-day decline in the daily infection rate, now 216 daily cases per 100,000 residents. On Friday it was 237.01, the highest ever.
Sixty-six of the state's 120 counties have above 200. The lowest rate, 62.7, is in Elliott County. The New York Times ranks Kentucky's rate 16th among the states.
In the reporting week ended Sunday, the state hit another case record and positive-test rate. It had 82,159 cases, more than 9,000 above the previous record-setting week, and a positivity rate of 33.1%, nearly four percentage points higher than the record set the previous week.
On Monday, the share of Kentuckians testing positive in the past seven days was 33.06%, meaning that one in three Kentuckians who get tested for the virus are positive. The number does not include at-home tests.
Offering a bit of hope, Stack said if Kentucky follows the case trends in Rhode Island, New York and the United Kingdom, Kentucky should reach its peak number of cases this week or next.
Gov. Andy Beshear said, "We hope that we are cresting, that we are near the peak of what we'll see. Remember, even if that's the case, it's going to take us at least a couple of weeks if not three to get to a much safer place."Stack noted that Kentucky's hospitalizations are nearing the all-time peak reached during the Delta surge, and said many Kentucky hospitals are struggling and at risk of running out of workers.
He said the virus is not hitting the lungs nearly as hard as it did as the other variants, but is infecting more people, including hospital workers.
Dr. Mark Dougherty, an infectious disease doctor at Baptist Health Lexington, said the same at a news conference with doctors from CHI Saint Joseph Health and UK HealthCare."One of the things that has been a little more difficult for us to handle during this surge is the fact that so many health-care workers are getting infected," Dougherty said.
He later added that he too thought cases will soon crest, if that plateau hasn't been reached already.
"I hope that's the case," he said. "We're strained. I think all the health-care systems are strained to the max in terms of taking care of people. And remember, when we're taking care of this many Covid patients, that means that we can't take care of other patients as well as we would like to."
Beshear said at least 33 Kentucky hospitals are reporting critical staffing shortages, "but to be fair, they are all experiencing major staffing challenges."
On Monday, Kentucky hospitals reported 2,326 Covid-19 patients, with 440 in intensive care and 257 on mechanical ventilation. Nine of the state's 10 hospital regions were using at least 80% of their intensive care unit capacity, with three above 90%.
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| Cabinet for Health and Family Services graph, adapted by Ky. Health News; click on it to enlarge. |
"As a parent, I never wanted . . . either of my kids to get Covid," he said. "But I got them vaccinated to ensure that they were protected if they did."
Stack said, "If you're a parent who has not yet had your sons and daughters vaccinated, please talk to your pediatrician, your primary care provider, ask them about the vaccines. The American Academy of Pediatrics, numerous other medical associations, and other public health bodies have all recommended vaccination. It's the safest way to keep kids healthy and well and in school and also to help protect their families at home who may be more vulnerable."
Stack also noted that the vaccine helps to reduce the risk of the multi-system inflammatory disease that sometimes strikes children a couple of months after the initial infection, and sometimes puts them in intensive care.
At the hospitals' news conference, Dr. Lindsay Ragsdale, interim chief medical officer at Kentucky Children’s Hospital, said the Covid-19 vaccine is 91% effective at preventing this inflammatory disease, called MIS-C, in children.
She also said the Children's Hospital, part of UK HealthCare, is seeing an uptick in Covid-19 hospitalizations. Today, it was reported that there are six pediatric Covid-19 patients.
Ragsdale strongly encouraged parents to get their children vaccinated, noting that she is worried because there has been a drop in the number of children getting vaccinated at their vaccine clinic.
Only 50% of 16- and 17-year-olds, 47% of 12-to-15-year-olds, and 20% of 5-to-11-year-olds in Kentucky have received at least one dose of a vaccine.
Another key message at the hospitals' news conference was that it's time to step up the quality of the masks we are wearing, to either a KN95 or an N95.
Dougherty said about 40% of Baptist Health Lexington's Covid-19 patients are admitted to the hospital for other reasons, which shows how prevalent the virus is in the community.
"It's ubiquitous. It's everywhere. It's hyper-contagious," Dougherty said. "And because of that, I think we need to step up the quality of masks that we're using," he said, adding that the advice applies both in and out of the hospital.
Ragsdale said KN95 masks for children are available, and encouraged parents to switch to them.
"It's probably the best masks that we can offer for kids," she said. "The cloth mask is better than nothing, but it's really not as good as a KN95 to prevent spread for pediatric patients. . . . For schools, this would be a great addition as well to preventing spread," she said.
Beshear was asked if the state was talking about supplying such masks to schools. He didn't answer directly, but said the state provides about $100 million in testing assistance and surgical or near-surgical level masks through the Covering for Kids program, but not KN95s.
Stack's advice was to "wear the best quality mask you can get that's well fitting as reliably as you possibly can -- so do the best you can with the best you have." He noted that the federal government will be shipping KN95 masks to pharmacies and states, and they will need to figure out how best to deploy those.
"But I agree with the governor," Stack said. "The first step is to require masks of any sort in the school setting, the next step then is to upgrade your masks. So I would be really grateful if we just got every student wearing masks to keep them in school safely." Beshear noted that some schools aren't requiring masks.The state reported 76 more Covid-19 deaths since Saturday, bringing the pandemic death toll to 12,763.
Stack said 23 of the deaths were in people 61 or younger, including one 20-year-old. Beshear said he draws attention to these deaths because 94% to 95% of all the Covid deaths in Kentucky since July 1 have been in unvaccinated persons.
"Unfortunately, these sufferings usually don't need to occur," he said. "Vaccination almost entirely eliminates this risk. So I do hope more folks will continue to get vaccinated and protect themselves from that horrible outcome."
UnitedHealthcare, nation's largest insurance company, posts record profit for an insurer; growth comes mainly from taxpayers
NEWS ANALYSIS by Wendell Potter
Just days after a Commonwealth Fund report showed that American families are sending health insurance companies more and more of their income every year even as their deductibles skyrocket, the country’s biggest insurer reported massive 2021 profits and told investors to expect even higher profits in 2022.
UnitedHealth on Wednesday reported 2021 profits of $24 billion on revenue of $287.6 billion. Executives told Wall Street they expect United will be the first insurer to take in more than $300 billion from its customers this year.
Instead of giving its health-plan customers relief from ever-increasing out-of-pocket requirements, United spent $5 billion last year buying back its own shares of stock, a gimmick that boosts the value of shares and makes shareholders richer. United also paid shareholders $5.3 billion in dividends in 2021.
No insurer has ever made that kind of money in U.S. history. It’s even more notable when you consider that United is not growing by attracting substantially more new customers.
At the end of 2021, United had about 26.6 million people enrolled in its commercial (individual and employer-sponsored) health plans. That’s just 700,000 more than the 25.9 million the company had 10 years ago. Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages. In other words, from us as taxpayers. United and other insurers are padding their top and bottom lines by charging their existing commercial customers higher and higher premiums every year.
Consider this: an employer-sponsored family policy that cost an average of $15,073 in 2011 cost $22,221 in 2021, a 47% increase, according to the Kaiser Family Foundation. And during that time, insurers have forced their health plan enrollees to pay more and more out of their own pockets through ever-increasing deductibles, copayments and coinsurance. Most Americans now have to pay on average twice as much out of their own pockets as they did 10 years ago.
That Commonwealth Fund report shows that with the relentless increase in both premiums and out-of-pockets, Americans are shelling out far more of their household income for health insurance and to cover out-of-pockets than a decade ago. Premiums and deductibles now take up more than 10% of median income in 37 states, up from just 10 in 2010.
Insurers argue that high deductibles are necessary to control premium increases. Unfortunately, most employers and policymakers seem to have bought that argument. But when you look at the research from both the Commonwealth Fund and Kaiser Family Foundation – and then the record profits United and other insurers are reporting – that talking point just doesn’t hold up.
Editor's note: UnitedHealthcare's parent firm, UnitedHealth Group, is the world's eighth largest company by revenue and second-largest health-care company behind CVS Health by revenue, and the largest insurance company by net premiums, according to Wikipedia. Wendell Potter is a former reporter Tennessee and Washington who spent more than two decades in the health insurance industry, first at Humana and then at Cigna as head of corporate communications. He has written three books: Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans (a New York Times bestseller and winner of the Ridenhour Book Prize in 2011); Obamacare: What’s In It for Me/What Everyone Needs to Know about the Affordable Care Act (an ebook); and Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It. His nonprofit corporation, To Be Fair, publishes news and commentaries on money in politics, propaganda, health care and other topics.
Just days after a Commonwealth Fund report showed that American families are sending health insurance companies more and more of their income every year even as their deductibles skyrocket, the country’s biggest insurer reported massive 2021 profits and told investors to expect even higher profits in 2022.
UnitedHealth on Wednesday reported 2021 profits of $24 billion on revenue of $287.6 billion. Executives told Wall Street they expect United will be the first insurer to take in more than $300 billion from its customers this year.
Instead of giving its health-plan customers relief from ever-increasing out-of-pocket requirements, United spent $5 billion last year buying back its own shares of stock, a gimmick that boosts the value of shares and makes shareholders richer. United also paid shareholders $5.3 billion in dividends in 2021.
No insurer has ever made that kind of money in U.S. history. It’s even more notable when you consider that United is not growing by attracting substantially more new customers.
At the end of 2021, United had about 26.6 million people enrolled in its commercial (individual and employer-sponsored) health plans. That’s just 700,000 more than the 25.9 million the company had 10 years ago. Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages. In other words, from us as taxpayers. United and other insurers are padding their top and bottom lines by charging their existing commercial customers higher and higher premiums every year.
Consider this: an employer-sponsored family policy that cost an average of $15,073 in 2011 cost $22,221 in 2021, a 47% increase, according to the Kaiser Family Foundation. And during that time, insurers have forced their health plan enrollees to pay more and more out of their own pockets through ever-increasing deductibles, copayments and coinsurance. Most Americans now have to pay on average twice as much out of their own pockets as they did 10 years ago.
That Commonwealth Fund report shows that with the relentless increase in both premiums and out-of-pockets, Americans are shelling out far more of their household income for health insurance and to cover out-of-pockets than a decade ago. Premiums and deductibles now take up more than 10% of median income in 37 states, up from just 10 in 2010.
Insurers argue that high deductibles are necessary to control premium increases. Unfortunately, most employers and policymakers seem to have bought that argument. But when you look at the research from both the Commonwealth Fund and Kaiser Family Foundation – and then the record profits United and other insurers are reporting – that talking point just doesn’t hold up.
Editor's note: UnitedHealthcare's parent firm, UnitedHealth Group, is the world's eighth largest company by revenue and second-largest health-care company behind CVS Health by revenue, and the largest insurance company by net premiums, according to Wikipedia. Wendell Potter is a former reporter Tennessee and Washington who spent more than two decades in the health insurance industry, first at Humana and then at Cigna as head of corporate communications. He has written three books: Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans (a New York Times bestseller and winner of the Ridenhour Book Prize in 2011); Obamacare: What’s In It for Me/What Everyone Needs to Know about the Affordable Care Act (an ebook); and Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It. His nonprofit corporation, To Be Fair, publishes news and commentaries on money in politics, propaganda, health care and other topics.
Sunday, January 23, 2022
CBO report issues report Yarmuth requested on health-care costs
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| Yarmuth (WBKO image) |
The report, “The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services,” examines potential reasons that the prices paid by commercial health insurers for hospitals’ and physicians’ services are higher, rise more quickly, and vary more by area than the prices paid by the Medicare fee-for-service program, Yarmuth's office said in a press release.
Yarmuth said in the release, “We know that our country and our economy are stronger when every American has access to quality, affordable health care. But CBO’s report finds that inefficiencies in our health-care system and market consolidation are driving up prices, forcing Americans to either forgo necessary coverage or face higher premiums and out-of-pocket costs, reduced benefits, or lower wages. Congress must do more to reduce this unacceptable burden on American families.”
Earlier, the CBO issued Yarmuth-requested reports on "Policies to Achieve Near-Universal Health Insurance Coverage" and "Key Design Considerations for Establishing a Single-Payer Health Care System."
