Tuesday, July 25, 2023
Sunday, July 23, 2023
Excess Covid-19 deaths grew in 2nd year despite vaccines; study cites shortage of rural vaccinations; Ky. fared worst during Delta
By Al Cross
Kentucky Health News
Scientists generally believe that the number of deaths attributed to the Covid-19 pandemic has been understated, and they point to what they call "excess deaths," the number of deaths above the number that would have been expected if the pandemic hadn't occurred, based on recent trends. A new study shows that excess deaths in the U.S. increased in the second year of the pandemic even though that is when Covid-19 vaccines became widely available, and that they went up largely because of increases in rural counties, where fewer people were vaccinated.
"In rural counties across the United States—where vaccines were harder to obtain, where vaccine skepticism remained higher, and where access to good health care is often more challenging—excess deaths in year two of the pandemic actually increased, despite the presence of vaccines," Boston University says of the study, done mainly by BU faculty and published in Science Advances. "The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every U.S. county in the pandemic’s first two years."
Andrew Stokes, an assistant professor of global health at BU and corresponding author of the study, pointed to a shortage of rural vaccinations as the main cause. The study reports, "In urban areas, 75% of people aged 5 years and older were vaccinated as of January 2022 compared to only 59% of people aged 5 years and older in rural areas. This urban-rural difference in vaccination rates more than doubled since April 2021." Stokes told the BU public-relations staff, "Inequalities in mortality outcomes in the second year of the pandemic were fundamentally shaped by patterns of vaccine uptake at the community level. . . . There was less vaccination happening in rural areas and that gap between urban and rural areas grew as the second year progressed." The difference rural and urban death rates largely disappeared early this year, The Daily Yonder reported in February.
"In rural counties across the United States—where vaccines were harder to obtain, where vaccine skepticism remained higher, and where access to good health care is often more challenging—excess deaths in year two of the pandemic actually increased, despite the presence of vaccines," Boston University says of the study, done mainly by BU faculty and published in Science Advances. "The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every U.S. county in the pandemic’s first two years."
Andrew Stokes, an assistant professor of global health at BU and corresponding author of the study, pointed to a shortage of rural vaccinations as the main cause. The study reports, "In urban areas, 75% of people aged 5 years and older were vaccinated as of January 2022 compared to only 59% of people aged 5 years and older in rural areas. This urban-rural difference in vaccination rates more than doubled since April 2021." Stokes told the BU public-relations staff, "Inequalities in mortality outcomes in the second year of the pandemic were fundamentally shaped by patterns of vaccine uptake at the community level. . . . There was less vaccination happening in rural areas and that gap between urban and rural areas grew as the second year progressed." The difference rural and urban death rates largely disappeared early this year, The Daily Yonder reported in February.
There were other factors, the study says: "The emergence of partisanship and misinformation further disadvantaged small metropolitan and rural areas during the second year of the pandemic. This partisanship even went as far as deteriorating the quality of surveillance data by affecting the certification of Covid-19 deaths, which were systematically undercounted in rural communities."
The study broke down the results by four main segments of the pandemic: the first six months, the first winter (October 2020 through February 2021), the surge of the Delta variant of the virus (August through October 2021) and the Omicron variant (November 2021 through February 2022). In Kentucky, the highest excess-deaths rates estimates were from the Delta surge.
The study says county-by-county data are important "because counties are the administrative unit for death investigation, excess mortality estimates have the potential to help identify counties where Covid-19 death rates differ from excess mortality rates and who might benefit from additional training and other resources around cause-of-death certification. These estimates may also be valuable for informing local public health workers, community organizations, and residents of the true impact of the pandemic, thus potentially increasing vaccination and uptake of other protective measures."
Here are the Kentucky sections of the county-by-county maps from the study, in chronological order, as adapted by Kentucky Health News. The high-resolution originals can be downloaded here. The study says these are estimates, and are uncertain in small counties.
Libertarians want to repeal 'certificate of need' permit process for health-care facilities, which say it needs reform, not repeal
Kentucky Health News
Without certificate of need, some facilities could close or stop offering services that don't make money, Kentucky Hospital Association President Nancy Galvagni told the task force. She said most services “are provided at a loss and must be subsidized by the few services from which hospitals derive revenue, such as elective surgery and . . . outpatient imaging. This is how hospitals pay for services such as behavioral health, obstetrics, emergency care, trauma care, and oncology, just to name a few.”
Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”
Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.
"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY.
One speaker at the Northern Kentucky event was state Rep. Marianne Proctor, R-Union, who has field a bill to repeal certificate of need for Boone, Kenton and Campbell counties.
“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”
The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:
Should Kentucky have a permitting process for health-care facilities or allow free-market competition? Or something in between? The General Assembly has begun debating the question, amid lobbying from a national libertarian group and health-care facilities that say unfettered competition would further complicate heath care and put some of them out of business.
When stand-alone birthing centers wanted an exemption from the state's "certificate of need" law this year, the legislature said no, but created a task force to examine the law and how it works. The task force heard July 17 from lobbies for hospitals, nursing homes home-health services and hospices, who think the law should be improved but not repealed, Sarah Ladd reports for the Kentucky Lantern. (This article is based largely on her story.)
 |
| Nancy Galvagni |
Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”
Tim Veno, president of Leading Age Kentucky, a lobby for nonprofits that provide aging services, told lawmakers that “over-duplication of health services can have multiple negative effects” on nursing homes. Too many nursing-home beds in an area could cause a home to close, or make staffing challenges worse, he said.
Home-health services also have staffing issues the inability to compete with hourly wages offered by places like Amazon and Target, said Evan Reinhardt, executive director of the Kentucky Home Care Association.
Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.
The week before the task force met, Americans For Prosperity promoted repeal of the certificate-of-need law at an event in Northern Kentucky. AFP is one of the groups funded by energy mangnate Charles Koch of Wichita, known for his spending on libertarian, conservative and Republican causes.
"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY.
AFP says it recently got the process repealed in South Carolina after 10 years of lobbying. "Kentucky is one of 35 states and the District of Columbia that operate certificate-of-need programs, which vary widely among the states, according to the National Conference of State Legislatures," Payne reports.
 |
| State Rep. Marianne Proctor |
“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”
The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:
- Reform the application and appeals process to save time, allowing providers to apply at any time, and have shorter hearings.
- In formal-review cases, require written statements saying why an application shouod be rejected.
- In expedited-review cases, limit challenges to the issue of need and whether the applicant qualifies for expedited review.
- Allow hospitals to provide services at an additional location in the same county without an additional certificate.
- Allow hospitals to get expedited review for converting beds to adult psychiatric care if the county has no such hospital.
Saturday, July 22, 2023
'Disrupting Addiction: A KET Forum' premieres Monday, July 24, to discuss the work being done to ease this public-health crisis
 |
| Kentucky Injury Prevention and Research Center map, enhanced by Kentucky Health News |
According to the state's annual Overdose Fatality Report, 2,135 Kentuckians died from a drug overdose in 2022. That was 5 percent fewer than in 2021, but many counties reported an increase in such deaths.
"Disrupting Addiction: A KET Forum" premieres Monday, July 24, at 8 p.m. ET on KET. It will be aired 21 more times on various days, times and channels through Aug. 9. To see the list of dates and times the program will air go to https:// ket.org/program/ket-forums/. It can also be viewed on the website KET.org.
The panelists include: Jimmy Cornelison, Madison County coroner; Eric Friedlander, secretary of the state Cabinet for Health and Family Services; Jennifer Hancock, president and CEO, Volunteers of America Mid-States; Bryan Hubbard, executive director and chair of the Kentucky Opioid Abatement Advisory Commission in the attorney general's office; Van Ingram, executive director of the state Office of Drug Control Policy in the Justice and Public Safety Cabinet; State Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee; and Dr. Devin Oller, University of Kentucky College of Medicine, primary care and addiction medicine physician.
The program will also feature reports from Isaiah House Treatment Center; Kungu Njuguna, an attorney who is recovering from alcohol and heroin addiction; and the Estill County Health Department, which now offers a syringe-service program through a mobile clinic after being shut down for several years.
Friday, July 21, 2023
State finds several water systems, most on the Ohio, have levels of 'forever chemicals' above a limit being considered by EPA
Kentucky Lantern graph from state data, adapted by Ky. Health News
By Liam NiemeyerKentucky Lantern
Per- and polyfluoroalkyl substances, commonly known as PFAS or “forever chemicals,” are in Kentucky’s rivers and lakes. The chemicals are accumulating inside Kentucky’s fish. They are in municipal water treatment systems, and some have levels higher than a proposed federal limit..
That is what the Kentucky Department for Environmental Protection has found the past few years as it has investigated how widespread PFAS is in Kentucky’s drinking water and environment, the department’s commissioner told state lawmakers Thursday.
“We have gathered a lot of information. None of the information that we’ve gathered has been or ever was intended to be used for regulatory purposes,” said DEP Commissioner Tony Hatton. “We’re looking at it primarily from a public-health standpoint, and primarily from a drinking-water aspect.”
Chemicals classified as PFAS have been used for decades in a wide variety of industrial purposes, from firefighting foam to nonstick cooking ware because they are highly heat-resistant and stick-resistant. The resistance comes from their strong chemical bonds; they are dubbed “forever chemicals” because they don’t break down easily in the environment.
These chemicals also have a wide range of potential detrimental health impacts at high levels: increased risk of some cancers, hormonal changes, increased cholesterol levels, decreased vaccine responses in children and more.
Hatton said the Energy and Environment Cabinet has done its “investigative work” and conducted the testing not only to be aware of how widespread PFAS was in state waters but to prepare for proposed federal regulations setting maximum limits on how much of some kinds of PFAS are allowed in drinking water.
The U.S. Environmental Protection Agency sets legal limits for over 90 contaminants in drinking water, but not for PFAS. EPA has health advisory limits, which are unenforceable, that advise how much PFAS exposure is needed over a lifetime before adverse health effects occur. That limit is set at .004 parts per trillion (ppt) for one version of the chemical.
The legally enforceable maximum limit the EPA is proposing would cap two types of PFAS at 4 ppt. State officials have found much higher levels of PFAS in some municipal water systems in Kentucky.
The water in the Greenup County town of South Shore had 23.2 ppt of one type of the chemical, the highest in the state, Louisville Public Media reported. And the 1,100 residents of the Ohio River town were not notified, state Sen. Robin Webb of Grayson, said at meeting of the Interim Joint Committee on Natural Resources and Energy.
“No notice requirements, people. And that’s a problem. I think we all have the right to be notified when we’re dealing with the commodity that’s necessary for life,” Webb said. “This is a big deal.”
In the sampling so far, most of the water systems with PFAS levels above the proposed federal limit are on the Ohio River. Earlier this year, the state sued the DuPont chemical company, alleging PFAS pollution in Kentucky from a West Virginia facility upstream on the Ohio. The state is demanding the company pay all past and future costs for monitoring and treating PFAS in drinking water.
Treating water for PFAS won't be cheap
Webb, a Democrat, said the Republican-dominated legislature should consider providing more funding to water systems in the next two-year budget, especially with the pending federal limit on PFAS.
Sen. Brandon Smith, R-Hazard, asked Hatton if forever chemicals had been seen in fish caught in Kentucky waters; the commissioner replied that a state report found PFAS in all of the 98 fish samples taken throughout the state.
Past Democrat-led efforts to regulate PFAS through state legislation have gained little traction. Rep. Nima Kulkarni, D-Louisville, has been the primary sponsor of bills the past three years to set maximum limits in drinking water and discharge limits into state waters. A version of the legislation in 2023 was not even assigned to a House committee.
Hatton said PFAS can be filtered out at water utilities, but treatment is expensive. He said the city of Leitchfield is asking the state for financial help to the tune of $1 million to implement a granular activated carbon filter.
“It’s great stuff, but once the receptors get filled, it doesn’t want to hold on to anything anymore, you have to regenerate it or replace it. So there’s gonna be ongoing costs,” Hatton said.
He said the state is focusing on how to treat drinking water systems for PFAS before addressing the other “complex” aspects of the issue, including the sources of forever chemicals.
Sen. Cassie Chambers-Armstrong, D-Louisville, urged officials to also address potential sources of PFAS exposure, for example, in children’s products, in addition to focusing on drinking water.
Cameron joins other GOP AGs in challenging Biden rule to block access to medical records of women leaving state for abortions
 |
| Attorney General Daniel Cameron |
Kentucky Health News
Attorney General Daniel Cameron joined fellow Republican attorneys general in opposing a proposed federal privacy rule to shield the medical records of patients who get reproductive health care services, such as abortions, in other states.
The June 16 letter that Cameron co-signed with 18 other attorneys general to the U.S. Department of Health and Human Services argues that the agency's proposed rule would upset the framework that safeguards the privacy of individual health information while permitting disclosure of information to state authorities to protect public health, safety and welfare.
Under the proposed rule states that have banned abortions would not be able to collect personal health information about these services from other states for investigations, lawsuits or criminal charges. This would “unlawfully interfere with states’ authority to enforce their laws and does not serve any legitimate need," says the letter.
Kentucky has no law forbidding women from going to other states to get abortions.
The proposed privacy rule would prevent states from obtaining private medical information “for a criminal, civil, or administrative investigation into or proceeding against any person in connection with seeking, obtaining, providing, or facilitating reproductive health care … outside of the state where the investigation or proceeding is authorized” and “is lawful in the state where it is provided.”
HHS defines "reproductive health care" broadly in the proposed rule and says it is inclusive of all types of health care related to an individual's reproductive system. These would include, but not be limited to, pregnancy, contraception, fertility, prenatal care, miscarriage management and abortion.The AGs' letter says that while the broad definition of reproductive heath care includes “health care related to reproductive organs, regardless of whether the health care is related to an individual’s pregnancy or whether the individual is of reproductive age.”
This, they argue, may allow the Biden administration "to advance radical transgender-policy goals" and "obstruct state laws concerning experimental gender-transition procedures for minors (such as puberty blockers, hormone therapy, and surgical interventions).”
Cameron said in a news release that the federal health-privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, balances privacy and public-interest concerns by allowing disclosure of certain information to law enforcement. Cameron says the proposed rule would interfere with this.
Cameron said in a news release that the federal health-privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, balances privacy and public-interest concerns by allowing disclosure of certain information to law enforcement. Cameron says the proposed rule would interfere with this.
Cameron writes, "HHS’s proposed rule exceeds the department’s legal authority. HIPAA authorizes HHS to set standards for protecting privacy in 'health information.' But HIPAA does not empower HHS to shield from authorities evidence of legal wrongdoing based on a claimed connection to 'reproductive health care.' The administration’s claims to the contrary could incentivize health-care providers to break state laws on everything from protecting unborn life to gender-altering surgeries."
The AGs' letter says the proposed rule would "curtail the ability of state officials to obtain evidence of potential violations of state laws."
Kentucky has two laws that largely ban abortion in the state. One bans abortion except to save the mother's life and another bans abortions after six weeks of pregnancy, when many women are still not aware that they are pregnant. These laws have forced women who want or need an abortion to do so in states where it is still legal.
This year, the General Assembly passed a law to ban gender-affirming medical care for transgender youth, which took effect last week when an injunction to block it was stayed, pending a future court ruling. This also creates a situation where families will likely seek care out of state.
The same day Cameron and other Republican AGs sent their letter, all 23 Democratic state attorneys general submitted a letter supporting the rule, with suggestions for how to make it stronger. "Given this rapidly changing backdrop of extreme legal risks and increasing uncertainty, it is critical that additional guardrails be added to the privacy rule to protect against the disclosure of reproductive health information,” they wrote.
This year, the General Assembly passed a law to ban gender-affirming medical care for transgender youth, which took effect last week when an injunction to block it was stayed, pending a future court ruling. This also creates a situation where families will likely seek care out of state.
The same day Cameron and other Republican AGs sent their letter, all 23 Democratic state attorneys general submitted a letter supporting the rule, with suggestions for how to make it stronger. "Given this rapidly changing backdrop of extreme legal risks and increasing uncertainty, it is critical that additional guardrails be added to the privacy rule to protect against the disclosure of reproductive health information,” they wrote.
The letter in opposition of the proposed rule was led by Mississippi Attorney General Lynn Fitch and includes attorneys general from Mississippi, Alabama, Alaska, Arkansas, Georgia, Idaho, Indiana, Louisiana, Missouri, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Utah.
Study shows link between intimate partner violence and risk of developing diabetes
 |
| People who experience intimate partner violence or the threat of it are much more likely to end up with diabetes, according to a new study published by a University of Kentucky researcher and others. AaronAmat, iStock / Getty Images Plus. |
By Sarah Ladd
Kentucky Lantern
People who experience intimate partner violence or the threat of it are much more likely to end up with diabetes, according to a new study published by a University of Kentucky researcher and others.
Experiencing violence, abuse and neglect as adults and children increased the risk of adult-onset diabetes in women and men by 23% to 35%, the study showed.
The findings were recently published in the American Journal of Preventive Medicine.
Researchers attributed the heightened risk to the elevated cortisol levels and suppressed insulin levels that occur in the human body in response to violence or chronic stress.
UK researcher Ann Coker, who’s also a professor of epidemiology in the Department of Obstetrics and Gynecology in the university’s College of Medicine, said the study is the first of its kind.
“Before this research, we knew that partner violence was associated with diabetes among women, but we did not know that violence preceded diabetes development,” Coker said. “We had no data on this relationship for men or within racial groups.”
People who experience intimate partner violence or the threat of it are much more likely to end up with diabetes, according to a new study published by a University of Kentucky researcher and others.
Experiencing violence, abuse and neglect as adults and children increased the risk of adult-onset diabetes in women and men by 23% to 35%, the study showed.
The findings were recently published in the American Journal of Preventive Medicine.
Researchers attributed the heightened risk to the elevated cortisol levels and suppressed insulin levels that occur in the human body in response to violence or chronic stress.
UK researcher Ann Coker, who’s also a professor of epidemiology in the Department of Obstetrics and Gynecology in the university’s College of Medicine, said the study is the first of its kind.
“Before this research, we knew that partner violence was associated with diabetes among women, but we did not know that violence preceded diabetes development,” Coker said. “We had no data on this relationship for men or within racial groups.”
Kentucky already has high rates of domestic violence
 |
| Ann Coker (photo provided) |
In 2020, the Centers for Disease Control and Prevention showed 11.4% of Kentuckians had diabetes, a decrease from the two years prior.
Diabetes is a chronic condition that hinders the body’s ability to make enough insulin to properly break down foods, per the CDC. There are several different types of diabetes.
More than 37 million Americans have diabetes, the CDC says, and many don’t know it.
Additionally, Kentuckians experience high rates of child abuse and adverse childhood experiences.
Researchers collected data for the study before the Covid-19 pandemic. The pandemic may have made the risk of diabetes worse by increasing stress, another researcher in the study said.
“Our findings also show an increased risk in a timeframe before the additional social stress of the Covid pandemic,” said Dr. Maureen Sanderson, the study’s lead author and a professor in the Department of Family and Community Medicine at Meharry Medical College, said in a statement.
“This strongly suggests the need for helping professionals across disciplines to implement effective violence prevention and intervention strategies to reduce the short and long-term social and health consequences of partner violence and child abuse,” Sanderson added.
Interventions, Sanderson said, can include “strengthening economic supports for families, promoting social norms to protect against adversity and violence, ensuring strong starts for children, teaching skills, connecting youth to caring adults and intervening to lessen harm.”
