Opinion: Covid-19 is mutating and apparently winning, so we need to take preventive measures well beyond vaccinations

Graphs by the New York Times, adapted by Kentucky Health News

By Kevin Kavanagh

There is no such thing as “herd immunity” for Covid-19. In this context it is a concept as antiquated as “the Earth is flat.”

The theory was based upon the work of William Farr in 1840 who proposed a bell-shaped curve which illustrated the body’s ability to mount a lasting response to an unchanging pathogen. As stated by one “herd immunity” supporter in the comments section of my previous article on this point, “The disease dies out because enough people have been exposed and developed relative immunity or died that the disease has no means of propagating itself on a large scale.”

That concept was formulated before science knew what viruses and mutations were, and that many biological systems are highly dynamic and constantly adapting. This is eloquently described in Steffanie Strathdee and Thomas Patterson’s book The Perfect Predator. It describes the biological dance between viral phages and their bacterial prey, each one adapting and re-engaging in a duel, the outcome of which is uncertain. With the exception of smallpox, no pathogen has ever been eradicated from the earth and with smallpox, eradication was achieved with a highly effective long-lasting vaccine.

With mutating RNA viruses such as SARS-CoV-2 (which causes Covid-19), “herd immunity” is an extinct construct. Unlike the relatively stable DNA virus of smallpox, RNA viruses have a much higher mutation rate.

The U.S. epidemiological curve of SARS-CoV-2 is a colliding roller coaster and nowhere near a bell curve. We have been hit with variant after variant; Delta infections transitioned to Omicron; and now we are struck by a soup of variants, composed of pathogens harboring a plethora of different immune-avoiding mutations, making the concept of “herd immunity” next to useless.

Unfortunately, SARS-CoV-2 appears to be the most adaptive and dynamic foe we have ever faced. Hoping that the antiquated concept of “herd immunity” will save the day, causing SARS-CoV-2 to “miraculously (go) away,” is just pure fantasy.

SARS-CoV-2’s high mutation rate is amplified by its extremely high infectivity. The CDC estimated that the Delta variant was as infectious as chickenpox, which has an R0 of 10 to 12. That means an average person infected with Delta infected 10 to 12 other people. Newer variants have evolved into some of the most infectious pathogens known to man. As the virus spreads it mutates. And as it mutates, it increases its ability to infect, evade our immunity and even attack our immune system.

Evidence is mounting regarding the immune dysfunction caused by SARS-CoV-2. We are seeing a dramatic rise in hospitalizations for the seasonal flu, respiratory syncytial virus (RSV) and even scarlet fever. The increase in RSV hospitalizations has been blamed on immunological weakening during the pandemic due to preventive measures such as masking. However, through November, the United States had correspondingly fewer RSV infections than in 2021, when an RSV surge was also seen. Germany also had a surge in RSV hospitalizations last winter, and now is seeing overwhelming RSV hospitalizations.

Not only does SARS-CoV-2 evade and attack our immunity, but the immunity is fleeting. The virus also resides in a variety of animal hosts where it can mutate and then reinvade the human population. Transmission of a mutated virus from whitetail deer to humans has been documented and there is evidence that Omicron originated in rodents then jumped to humans in South Africa.

The dangers of long Covid, persistent cardiovascular disease, blood clots and a plethora of mental problems caused by Covid-19, are real, and are adversely affecting the health of our workforce and our communities.

Our goal must be to decrease pathogen spread so society can function, with infections decreasing to a level that we can live with the virus. In this regard, it appears the virus is currently winning.

We need to embrace vaccinations, the use of N95 masks in crowded venues, along with home delivery, curbside pickup and outside dining. Indoor air quality must be improved to the point where it is safer indoors than it is outdoors.

If we continue to be a society focused on individualism rather than community or public health, I am afraid we will lose this fight. We need a paradigm shift in the way we strategize to control Covid-19, away from “herd immunity” and towards adapting our lives to live with this highly dynamic and constantly adapting foe.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA. This is an edited version of his original article, published in the Courier Journal.

New York Times chart, adapted by Ky. Health News; to enlarge, click on it; to download, right-click.

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Kentucky counties and cities get first installment of money from national opioid settlements, now must decide how to spend it

Route Fifty photo

By Melissa Patrick
Kentucky Health News

Kentucky's cities and counties have received their first installment of the state's money from the national opioid settlements, most of which must be used to combat the opioid epidemic.  

Knox County Judge-Executive Mike Mitchell said he is exploring how to get the most from the $365,000 or so that the economically distressed county in southeastern Kentucky got from the settlements in 2022, including partnerships with other organizations or implementing programs that focus on prevention, education, re-entry and rehabilitation.

Mitchell said any decisions about how to spend it will require input from the community and a Fiscal Court vote. "We will be very cautious about what we do," he said. "We want the maximum benefit out of this for the community and to make sure that it's being applied to fill the needs that it is intended for."

The money comes from a $26 billion settlement with drug maker Johnson & Johnson and a $478 million deal with the nation's three top drug distributors, Cardinal Health, AmerisourceBergen and McKesson Corp. In Kentucky, half the money will go to the state and the other half will go to local governments. The state's allotment will be distributed by the Opioid Abatement Advisory Commission, headed by Attorney General Daniel Cameron. 

Mitchell said that while he is pleased to get help to fight the opioid epidemic, no amount of money will fix the damage that's been caused by the drug companies.

"It's unfortunate that Kentucky's eligible to receive this because there's no way to replace the damage that's been done by the pharmaceutical people," he said. "I feel they're totally to blame. That's a big part of our drug problem, in the way this opioid was misrepresented. . . . It's not an exorbitant amount of money, for the damage that they've done. . . . There's no way to go back and re-do the impact that they've had in our community." 

Kentucky has been one of the states hardest hit by the opioid epidemic. In 2021, the state recorded 2,250 overdose deaths, with 73% of the deaths involving fentanyl. 

How much did your city or county get? 

Every Kentucky county received its first allotment of settlement money in December, ranging from a $15,994 in Robertson County to $6.7 million in Jefferson County. The Kentucky Association of Counties has posted online the estimated allocations for every county through 2038. 

The Kentucky League of Cities reports that 149 Kentucky cities have received an allocation from the settlement and provides a list of the settlement amounts for each participating city for 2022 and 2023; 28 Kentucky cities have not yet signed on to the settlement participation agreement, but remain eligible. If a city did not qualify for at least $30,000, its allotment was rolled into its county's allotment. 

State law says no less than 85% of the proceeds received by each local government "shall go toward abatement of the opioid epidemic in those communities." It defines acceptable use of the funds and includes a wide range of criteria and guidelines for reimbursement of prior expenses and the funding of new programs related to prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorder, or mental health issues. 

Each year, local governments must tell the Opioid Abatement Advisory Commission how they are spending the money. That agency "is not responsible for the allocation of opioid settlement funds to Kentucky cities and counties," Krista Buckel, communications director for Cameron's office, said in an e-mail.

How were the allocations determined? 

The amount for each local government was based on "population adjusted for the proportionate share of the impact of the opioid epidemic," according to a National Opioid Settlement FAQ fact sheet. Impact was  determined by the amount of opioids shipped to the state, the number of opioid-related deaths, the number of people with opioid-use disorder in the state, and each political subdivision's proportionate share of those numbers.

"Adjustments were made to reflect the severity of impact because the oversupply of opioids had more deleterious effects in some locales than in others," the fact sheet says. "Ultimately, the model allocates settlement funds in proportion to where the opioid crisis has caused harm." 

Asked for details on how the money was divided between cities and counties, Jennifer Burnett, director of policy, research and communications for the counties association, said they "were assigned a . . . ranking percentage based on three or four data points," and the money was distributed based on a formula applied by Brown Greer PLC, the settlement administrator. Brown Greer, a Richmond, Va., law firm, did not reply to a request for further explanation. 

 

A stated desire to spend the money wisely

Manchester Mayor Steve Collins was just two days on the job when he told Kentucky Health News that he had already reached out to the attorney general's office to get details on how settlement money could be spent. KLC estimates that Manchester received $15,587 from the settlement in 2022. 

"I think it's urgent that we spend it, but I also think it's very important that we . . .  discuss what would be the best way to spend it," he said. "I think that's the main issue, making sure we put it in the right direction. Just do not hurry and spend it to be spending it, but spend it to be actually the most beneficial to the community." 

Woodford County Judge-Executive James Kay said his county already had an Opioid Task Force and there may be several initiatives in place or in discussion that the money could help. He said combining money with other organizations could heighten its impact, and said he would ask the public how they would like to see it spent. The counties association estimates that Woodford County received $123,595 from the settlement in 2022. 

"We want to make sure that we spend the money wisely, efficiently and effectively," Kay said.

Versailles Mayor Brian Traugott said he would like to see the city's settlement money spent on prevention, particularly in finding ways to keep young people busy and off of drugs. In addition, he said it will be important to consider programs that help with "post-treatment" and second-chance employment. KLC estimates that Versailles received $17,551 in settlement funds in 2022. 

Traugott added that it will be important to get "boots on the ground" people involved with how to spend the money as a way to make sure "that we are utilizing these funds in an effective way." 

Cameron recently announced additional settlement agreements with Walmart, Teva Pharmaceuticals and Allergan for their roles in the opioid epidemic. Money from these settlements will also be divided between the state and local governments, with the same requirements. 

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New coronavirus cases went down 60% in Kentucky last week, but new hospitalizations of patients with Covid-19 rose 18.5%

New York Times chart, adapted by Ky. Health News, shows new admissions of patients 70 and older with Covid-19 rose from Dec. 25 to Jan. 1. The latest state report covers admissions as of Jan. 2.

By Melissa Patrick
Kentucky Health News

Kentucky reported 60 percent fewer new coronavirus cases last week, but the positive-test rate rose a bit and hospitalizations jumped more than 18 percent.  

The state Department for Public Health's latest weekly report, released Tuesday because of the New Year's holiday, showed 3,532 new cases of Covid-19, or 504 per day. That's down from 1,274 per day in the prior week, when the state saw a 40% increase in cases over the previous week. 

Only 2% of this week's reported cases were in people 18 and younger, perhaps the lowest number yet reported, and probably reflecting school holidays.

The share of Kentuckians testing positive for the virus in the past seven days increased slightly, to 12.74%, up from 12.23%. The week before that this rate was 9.85%. 

It's important to remember that the actual numbers are likely much higher, since the reported percentage doesn't include at-home tests. And as Gov. Andy Beshear has said, by the time a person gets a Covid-19 test that is analyzed by a laboratory, they are pretty sure they have some sort of infection. 

Hospitalizations kept rising. Kentucky hospitals reported 480 patients with Covid-19, up 18.5% from 405 a week earlier, with 58 in intensive care (up nine) and 24 on mechanical ventilation (up eight). 

The weekly new-case incidence rate was 14.6 cases per 100,000 residents, up just slightly from 14.54 the week before. The top 10 counties were Robertson, 54.2 cases per 100,000; Elliott,43.7; Lee, 38.6; Simpson, 35.4; Monroe, 32.2; Bath, 30.9; Owsley, 29.1; Bell, 28.5; Lyon,27.8; and Leslie, 27.5.

The New York Times continues to note that Kentucky and South Carolina are in the midst of worsening conditions. On Wednesday, the Times ranked Kentucky's incidence rate 42nd in the nation, with a 57% decrease in the last two weeks.

Kentucky attributed 27 more deaths to Covid-19 last week, down from 45 the week prior. The state's pandemic death toll is now 17,697.  

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Newly dominant variant more likely to evade Covid-19 antibodies, but so far not seen as more likely to cause serious disease

With a new subvariant of the novel coronavirus now dominant in the U.S., vaccinated people may be more likely to develop Covid-19 but still be protected from serious disease, according to preliminary reports.

The XBB.1.5 subvariant "has raised concerns about another potential wave of Covid cases following the busy holiday travel season" but "There’s no indication it causes more severe illness than any other omicron virus, Dr. Barbara Mahon, director of CDC’s Coronavirus and Other Respiratory Viruses Division, told NBC News. . . . The CDC projected Friday that about 40% of confirmed U.S. Covid cases are caused by the XBB.1.5 strain, up from 20% a week ago."

XBB.1.5 so new that research on it is very limited, but researchers from Columbia University recently reported in the journal Cell that sublineages of the BQ and XBB subvariants had a “dramatically increased” ability to evade antibody protection, even among those who had received the current bivalent booster. “However, it is important to emphasize that although infections may now be more likely, Covid-19 vaccines have been shown to remain effective at preventing hospitalization and severe disease even against Omicron as well as possibly reducing the risk of post-acute sequelae of Covid-19 (PASC, or long Covid),” the researchers reported.

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Beshear's medical cannabis order takes effect, but access for most isn't easy; prospect of legislative action remains unclear

USA Today map adapted by Kentucky Health News; data from Marijuana.procon.org

By Al Cross
Kentucky Health News

People with a medical provider's statement saying they suffer from at least one of 21 specified medical conditions can now possess up to eight ounces of marijuana for medicinal purposes in Kentucky, if they bought it legally in another state, under an executive order issued by Gov. Andy Beshear that took effect Jan. 1.

But for most Kentuckians, exercising the new right is not convenient, because cannabis is not legal in any form in Indiana and Tennessee, and the medical-cannabis laws of Ohio and West Virginia do not apply to out-of-state residents.

Missouri and Virginia have passed laws to legalize cannabis for recreational use, but the Missouri law is not expected to take effect until at least February, and Virginia is not expected to have cannabis dispensaries until next year, reports Joe Sonka of the Courier Journal. That leaves Illinois.

Asked about that at his year-end press conference, Beshear said, "The executive order isn’t going to make it convenient for anyone . . . What it will ensure is that they’re not a criminal" if they qualify and have eight ounces or less, the amount that is otherwise a misdemeanor in Kentucky. Beshear's order uses his pardon power to prevent prosecution of those who qualify.

"I don't want them to have to drive to Illinois, but that takes an act of the legislature," Beshear said. "I want our people to be able to get it close to home."

It is unclear what the Republican-controlled General Assembly will do in reaction to the Democratic governor, who is on the ballot this year. The state Senate has refused to move two medical-cannabis bills passed by the House, so there is some feeling that the bill should start in the Senate this time, but Senate Majority Floor Leader Damon Thayer, R-Georgetown, says it should start again in the House.

That does not suit Rep. Jason Nemes, R-Louisville, the sponsor of those two bills. "This is a Senate question; it is no longer a House question,: Nemes said Jan. 1. "There's no reason to go through the House again, becase that would delay the prospect of the bill." The current session is a short one, with only 30 legislative days, unlike the 60 days in even-numbered years.

Beshear said Thursday that Kentucky law-enforcement officers would have by Jan. 1 a palm card instructing them how to handle cases in which they find eight ounces or less of marijuana (any more would be a felony) possessed by someone authorized to possess it under the executive order.

The medical provider's written certification must include their medical license number, a statement of a the provider-patient relationship, their diagnosis of the qualifying medical condition, and their dated signature. It must also have the provider's and patient's names, addresses and phone numbers.

The 21 qualifying conditions are including cancer, HIV or AIDS, multiple scleroisis, muscular dystrophy, epilepsy, intractable seizures, intractable pain, severe and chronic pain, severe arthritis, neuropathy, Parkinson's disease, fibromyalgia, glaucoma, Crohn's disease, sickle-cell anemia, post-traumatic stress disorder, hepatitis C, cachexia (wasting syndrome), Huntington's disease, amytrophic lateral sclerosis (Lou Gehrig's disease) or another terminal illness.

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

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

Robert Slaton, Ed.D.

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

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

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

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

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

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

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

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

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

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