As surge continues, Beshear won't rule out new measures, makes red-zone recommendations, says schools face 'difficult questions'

State Dept. for Public Health graph, with ratios added by Ky. Health News, shows how the infection rate declined as the vaccination rate increased, and while the Delta variant has broken through in some vaccinated people, the infection rate among unvaccinated people is still five times higher.

By Al Cross

Kentucky Health News

With Kentucky averaging almost 1,000 new cases of the coronavirus a day, Gov. Andy Beshear said Thursday that he is willing to re-impose restrictions to thwart the resurgence of the pandemic, and issued new cautions for counties than have reach what the state calls a critical level of virus spread.

"We're not gonna be afraid to make the tough decision if it's merited," he said, adding later, "If I think we have to take steps to save lives, we're gonna do it."

He disputed claims that he lacks power to issue emergency mandates, but pointed out that "Our world's entirely different" than it was when he imposed a mask mandate and other restrictions last summer because "people can now protect themselves" with a vaccine, "so our decision calculus will be very different."

Beshear displayed statistics showing that since March 1, unvaccinated Kentuckians have accounted for 95 percent of new cases in the state, 92% of hospitalizations and 89% of deaths.

He said his decisions on restrictions would be based on the number of hospitalizations, "what the outcomes are and how sick individuals are. We will also be looking at the breakthrough rate," the percentage of new cases among vaccinated people. "We're going to see how this goes pretty quickly."

He said vaccines provide "some pretty significant protection for you" against the more contagious Delta variant, but "If you are unvaccinated, it is the deadliest form of Covid we have seen." He noted that Dr. Scott Gottlieb, head of the Food and Drug Administration under Donald Trump, said unvaccinated people should expect to catch the virus and have the worst illness they have ever had.

Asked what he would tell vaccinated people about the variant, Beshear said the vaccines "provide very serious protection" against getting it, and even if you get it, "They provide you significant protection form getting really sick or dying." He said vaccinated people should "Take the steps you feel like you need," such as wearing a mask when grocery shopping.

Health Commissioner Steven Stack said, "There's no debate among anyone who looks at science and fact seriously: The vaccines work, they protect you, and if you couple that with some other simple steps if you're vulnerable, like wear a mask, wash your hands and keep some distance, you can go out in the world and enjoy your life again, not like we were last year."

Hotspots: The state reported 933 new cases of the virus Thursday, making a three-day average of 983 and a seven-day average of 649, which was a 9% jump from Wednesday. Beshear said he expects the state to have more cases in the current Monday-through-Sunday reporting week than in the previous week.

State Department for Public Health

Thirteen of the 120 counties are now in red on the state's infection map, meaning they have seven-day new-case rates above 25 per 100,000, which the map labels "critical." Beshear issued several recommendations for such counties, including postponement of large public events.

Asked if that includes athletic contests or religious gatherings, the governor said those in charge should consider the size of the event, precautions such as distancing and masking, and the ability to move the event outside and reduce capacity. "Our goal here is to highlight the concern about what large events can do, 'cause we've had . . . more clusters [of cases] than at any time since the vaccine was introduced."

He said most of the recent clusters have been among people under 50, and displayed an updated table of vaccinations by age.

DPH chart, adapted by KHN

Because of low vaccination rates among younger people, the Delta variant's greater impact on them (24 percent of Thursday's new cases were 18 and younger) and the inability of children under 12 to be vaccinated, school districts face some tough decisions as they prepare to resume classes. The state and the Centers for Disease Control and Prevention have recommended masks for the unvaccinated in schools, but at this point any mandates are up to school districts.

Kentucky Health News asked Beshear if he is considering doing what a fellow Democrat, North Carolina Gov. Roy Cooper did this week: require students in grades K-8 to wear masks. "We will have to look at and answer that question," in cooperation with the Kentucky Department of Education, he said.

"We're gonna be talking with KDE later this week," Beshear said. "I think there are some difficult questions we have to address. . . . I see a whole lot of people gearing up because they want to have some fight about this, but the basic facts are, if you want your kids to be in school every day of the next year, the only way to make sure that happens is to get them vaccinated or to make sure that there are other protections in place."

Education Commissioner Jason Glass told Lexington's WKYT-TV that he is encouraging districts to follow the CDC guidance, and notes that they might incur legal liability for Covid-19 cases if they don't.

Vaccination persuasion: Though school is fast approaching, vaccinations in Kentucky have been at a low level for weeks, and over the past week are averaging about 6,000 per day.

Asked what can be done to get more people vaccinated, Beshear said, "I know you're not going to take it from me at this point. . . . We're at a point where those who are unvaccinated aren't listening to any public official." 

He said vaccination persuasion has to come from local leaders and friends of the unvaccinated: "We need every individual to make a few more efforts to talk to their friends and family."

Stack, a physician, said that when making those efforts, "You can't be judgmental" or "try to tell them you know better."

Also, Beshear said, there needs to be more communication between doctors and patients. "People aren't actually calling their doctors and talking to them about it," he said.

To encourage vaccination, the state is holding three lottery-style drawings at which one adult wins $1 million and 10 children win full scholarships for post-secondary education. The first was held July 2. 

Beshear said almost 700,000 vaccinated adults and almost 40,000 vaccinated children have signed up, about a third of the vaccinated population. "We do believe that this drawing working, at least to some degree," he said. The second and third drawings will be July 29 and Aug. 26.

Employees of nursing homes, which house people who are most vulnerable to the virus, have about the same vaccination rate as the entire population. Few nursing homes have required employees to be vaccinated, saying they are afraid to lose employees when they are short of help. The American Hospital Association said Thursday that it stands behind members who require vaccinations.

Beshear has said he would not mandate vaccination of anyone. Kentucky Health News asked him if incentives to the employees might get more of them vaccinated. "That's an interesting question," he said. "Let us think about that." He said he supports any employer who requires vaccinations.

Daily numbers: The share of Kentuckians testing positive for the virus in the last seven days rose for the 28th day in a row, to 6.63%. Stack said the increase is concerning.

The seven-day infection rate rose for the 16th consecutive day, to 13.87 per 100,000 residents. Counties with rates more than double that rate are all in the red zone: Washington, 41.3; Muhlenberg, 40.1; Webster, 39.7; Clay, 38.8; Laurel, 35.7; Hart, 34.5; Hopkins, 32.9; Hancock, 31.1; Whitley, 29.2; Jackson, 28.9; Floyd, 28.9; and Barren, 27.8. Letcher, at 27.2, is also in the red zone.

Hospitalizations also continued to increase. Kentucky hospitals reported 423 Covid-19 patients, the most since May 12; 124 of them are in intensive care and 50 are on a ventilator.

The state reported two more Covid-19 deaths, raising the pandemic toll to 7,308.

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Closed hospitals in Ky. border counties in Va. and W.Va. are reopening, one as part of a chain, one bought by a local clinic

Its old slogan: "Your Friends on the Hill." (HD Media photo)

"Rural hospitals must leverage the full resources of their communities in order to survive." That's the "most critical" lesson learned from last year's closing of Williamson Memorial Hospital in West Virginia, Taylor Sisk writes for National Geographic in a well-illustrated story about hospital closures in Appalachian counties bordering Kentucky.

The hospital is "scheduled to reopen, most likely in the fall," Sisk reports. It has been bought by the Williamson Health and Wellness Center, "a federally qualified health center that over the past few years has been a catalyst in the community for a wide range of public health initiatives" in a county ranked the state's second unhealthiest. But keeping people healthy also keeps them out of hospital, so "The health of the community and viability of its hospital will be dependent on a successful symbiosis."

The solution to the hospital's problem is not typical, but could provide a lesson to rural communities at a time when rural hospital closures are accelerating and one in five rural hospitals have been estimated to be at risk of closing due to financial difficulties.

"In some cases, the answer is the merging of hospitals or acquisition by an outside entity, solutions that offer economy of scale—purchasing power, consolidated administration, access to advanced technology—but come at the risk of the loss of attention to the community’s needs and concerns," Sisk writes. "The other option, maintaining an independent hospital, is increasingly difficult. Doing so requires rethinking."

There's another unusual aspect to the Williamson hospital, which once billed itself as "Your Friends on the Hill." Sisk notes, "There’s another hospital just a couple of miles from Williamson, across the Tug Fork [of the Big Sandy] River in Kentucky," Tug Valley ARH Regional Medical Center in South Williamson. "But crossing state lines creates issues with insurance, both public and private. The closest in-state hospital is 35 minutes away in Logan. Neither hospital is home to 'Your Friends on the Hill'."

Sisk also looks at the closed Jellico Medical Center on the Kentucky border in Tennessee, which has had more hospital closures, population-wise, than any other state; and at Lee County Community Hospital, at Virginia's western tip, which reopened July 1 "under ownership of the region’s new health-care behemoth, Ballad Health. Ballad is the product of the merging in 2018 of two hospital systems—Mountain States Health Alliance and Wellmont Health System. They were competitors in southwest Virginia and eastern Tennessee, an arrangement most health-care observers in the region agree was impractical. In exchange for approval of the merger, the hospital systems signed agreements with Tennessee and Virginia regulators committing to addressing persistent public-health concerns. Ballad selected as its primary areas of focus substance misuse, tobacco use, obesity, and childhood trauma."

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National settlement would bring Kentucky and its local governments $460 million over 18 years to fight opioid epidemic

Opioid tablets (Getty Images photo)

Kentucky's Daniel Cameron and other state attorneys general announced Wednesday a tentative settlement with the nation’s three top drug distributors and drug maker Johnson & Johnson for their role in "creating and fueling the opioid epidemic," as a Cameron press release put it.

The $26 billion deal with J & J, Cardinal Health, AmerisourceBergen and McKesson Corp. would resolve more than 4,000 claims that states and local governments have made in various courts, and bring an estimated $460 million to Kentucky, which state and local governments would split 50-50 over 18 years.

"The substantial majority of the money is to be spent on opioid treatment and prevention," Cameron said at a briefing. His release said "Each state’s share of the funding has been determined by agreement among the states using a formula that takes into account the impact of the crisis on the state – the number of overdose deaths, the number of residents with substance use disorder, and the number of opioids prescribed – and the population of the state."

Kentucky has been one of the states hardest hit by opioid abuse, which the pandemic has worsened. It had the second-highest percentage increase in overdose deaths in 2020.

The state's use of its share would be overseen by a new Opioid Abatement Advisory Commission, authorized by the law the legislature passed to create the 50-50 split.

States have 30 days and local governments 150 days to adopt the settlement. Connecticut Attorney General William Tong said on PBS that he expects all states to adopt it. "A huge majority of states must sign on for the deal to proceed, although the companies have not specified an exact number," reports Jan Hoffman of The New York Times. "If that threshold is not met, the companies could walk away and litigation would resume."

If that happens, Cameron said he would continue fighting in court, and "Justice ultimately will be served."

The agreement "leaves thousands of other lawsuits against many other pharmaceutical defendants still unresolved, including manufacturers, drug-store chains and smaller distributors," Hoffman notes. "Most of those companies are working on negotiating their own deals, which could potentially bring even more money to states, cities, counties and tribes. Purdue Pharma, the maker of OxyContin and its owners, members of the billionaire Sackler family, are negotiating a $4.5 billion settlement with plaintiffs as part of a bankruptcy restructuring."

Republican state Rep. Danny Bentley of Russell, who sponsored the law on the settlement, called the deal "an important step toward remediating the opioid epidemic in Kentucky. Our citizens have suffered for far too long, and this settlement, once final, will allow Kentucky to combat that suffering."

Under the agreement, Johnson & Johnson would stop selling and promoting opioids, and the three distributors would create a centralized, independent clearinghouse for data and analytics "about where drugs are going and how often, eliminating blind spots in the current systems used by distributors," Cameron's release said. They would "terminate customer pharmacies’ ability to receive shipments, and report those companies to state regulators, when they show certain signs of diversion." Also, they must "prohibit sales staff from influencing decisions related to identifying suspicious opioid orders" and "require senior corporate officials to engage in regular oversight of anti-diversion efforts."

Under a headline, "Too Little, Too Late?" The Economist says, "The payments cannot eradicate the damage that has been done. (Indeed, the companies continue to deny any wrongdoing.) The Centers for Disease Control and Prevention estimate that almost a half a million Americans died from opioid overdoses between 1999 and 2019. And the crisis is far from over. Almost three-quarters of recorded overdose deaths in America last year were linked to opioids."

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Kentucky reports 963 new coronavirus cases; its rate of increase over last the last two weeks, 256%, ranks 15th in the nation

Screenshot of New York Times interactive map with seven-day new-case average; click to enlarge.  

By Al Cross

Kentucky Health News

The pandemic continued to resurge in Kentucky Tuesday, part of a national trend that began more than three weeks ago but also perhaps showing the effects of hotspots in nearby states.

Kentucky reported 963 new cases of the coronavirus, raising the seven-day rolling average to 596, more than triple what it was three weeks ago.

That made the infection rate over the last seven days 12.67 per 100,000 people, more than four times the low of 3.13 recorded on June 27.

Counties with infection rates more than double that rate are Washington, 42.5; Clay, 39.5; Muhlenberg, 38.7; Webster, 38.6; Hart, 35.3; Hopkins, 33.2; Laurel, 31.7; Hancock, 31.1; Lewis, 28; and Whitley, 27.2. Coincidentally, those are the counties that the state's new-case map shows in red because their rates are above 25 per 100,000.

The share of Kentuckians testing positive for the coronavirus rose for the 26th straight day, to 6.12 percent. That is almost double what it was just 12 days ago. The low was 1.79% on June 25.

Hospitalizations for Covid-19 have approximately doubled in the last month. Wednesday they totaled 380, with 115 in intensive care and 59 of those on a ventilator, the most on ventilators since June 2.

The state reported two more deaths from Covid-19, raising the total to 7,306. Kentucky is averaging about four Covid-19 deaths per day this month.

The surge in new cases is driven by the variant of the virus known as Delta, estimated to be at least 83% of recent new cases in the U.S. The national hotspots are Missouri and Arkansas, and the New York Times county-level map of new cases suggests that the variant is spreading eastward into Kentucky from those states. The Times ranks Kentucky 15th in the nation in rate of increase over the last two weeks, 256%.

CBS News reported that the viral load of the variant is 1,000 times larger than the original, and may even turn off the immune system briefly, allowing it to take over the body.

The surge has prompted health experts and politicians of both parties to implore Americans to get vaccinated, but vaccinations have gone flat and less than half the population, 48.8%, is fully vaccinated; 56.3% have had at least one dose. In Kentucky, 44.9% are fully vaccinated, and 50.9% have had at least one dose. Among the eligible population, 12 and older, 59.7% have had at least one dose.

But the overall vaccination rate in most counties is below 40%, and in at least 11 it is below 25%: Ballard, Christian, Hickman, Spencer, Robertson, Carlisle, Clinton, Lewis, McCreary, Elliott and Jackson, according to the state vaccination dashboard.

In full vaccination, Franklin County leads with 61%, followed by Woodford, 59%; Fayette, 56%; Jefferson, 52%; and Boone, 51%. The bottom five are Spencer, 20%; Christian, 23%; Lewis, 24%; Jackson, 24%; and Elliott, 25%. For full-vaccination data from the Centers for Disease Control and Prevention, via The Washington Post, click here.

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McConnell says to ignore 'demonstrably bad advice' from vaccine skeptics, and get vaccinated to control the pandemic

By Lisa Mascaro
The Associated Press

Senate Republican leader Mitch McConnell implored unvaccinated Americans Tuesday to take a Covid-19 shot, issuing a stark and grave warning of a repeat of last year's shutdowns if people refuse to protect themselves from the coronavirus.

McConnell urged Americans to ignore the “demonstrably bad advice” coming from pundits and others against the vaccines. As caseloads skyrocket, he noted that nearly all the new virus hospitalizations in the U.S. are among people who have not been vaccinated.

“If there is anybody out there willing to listen: Get vaccinated,” McConnell said at his weekly press conference at the Capitol.

“These shots need to get in everybody's arms as rapidly as possible or we’re going to be back in a situation in the fall that we don't yearn for — that we went through last year,” he said. “This is not complicated.”

McConnell has been one of the most outspoken members of his party in urging vaccinations to stop the virus spread, speaking often in Kentucky of the need for people to get the shot.

Without criticizing prominent Republicans who refuse the vaccine or mock the severity of the virus, including members of Congress, he has expressed dismay at those who choose to go unvaccinated.

As a survivor of childhood polio, McConnell often draws on his own experience of having endured that disease and he has spoken publicly of the relief that eventually came with the development of vaccines.

On Tuesday he said “it never occurred to me” that after the Covid-19 vaccines that were quickly developed for use in the U.S., “we'd have difficulty getting Americans to get the shot.”

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Paul-Fauci feud escalates; they trade allegations of lying

Dr. Anthony Fauci and Sen. Rand Paul faced off at a Senate committee hearing Tuesday.

The long-running acrimony between U.S. Sen. Rand Paul and Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, escalated Tuesday, as Paul strongly implied that Fauci had lied to Congress, and Fauci told Paul that if anyone was lying it was him and "You do not know what you are talking about." 

The battleground was, as usual, a Senate committee hearing. "In his questioning of Fauci, Paul stepped close to the line of accusing Fauci of lying to Congress in previous testimony in which he said that the NIAID had never funded gain-of-function research in China," reports Tyler Olson of Fox News. 

Gain-of-function research can lead to pathogens becoming stronger. "Citing a paper on research about bat coronaviruses, Paul said that U.S. money had essentially gone to the hazardous and controversial research – an assertion Fauci strongly objected to," Olson reports.

"Fauci had denied that the health institute ever funded gain-of-function research at a Wuhan lab," the Lexington Herald-Leader reports. Paul asked Fauci, "Knowing that it is a crime to lie to Congress, do you wish to retract your statement of May 11, where you stated that NIH never funded gain-of-function research in Wuhan?"

Fauci replied, “I have never lied before the Congress, and I do not retract that statement.”

Paul "continued to press Fauci, making claims that the viral studies being done were gain-of-function, which Fauci again denied," the Herald-Leader reports.

Fauci, clearly angered, said, “Senator Paul, you do not know what you are talking about, quite frankly, and I want to say that officially. You do not know what you are talking about.”

The Herald-Leader reports, "The two proceeded to talk over each other until Paul’s speaking time expired, at which point he said Fauci 'won’t admit the truth'." Fauci replied, “You are implying that what we did was responsible for the deaths of individuals. I totally resent that, and if anybody’s lying here, senator, it is you.”

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"Paul replied by saying the health institute’s actions 'could have been' responsible for deaths," the Herald-Leader reports. "Fauci said there was a 'pattern' of Paul trying to argue with Fauci 'based on no reality'."

Paul's allegation was not new, but attention remains focused on the Wuhan lab because the Chinese government has not permitted a full investigation of it as a possible source of the virus. Last week, CNN reported, "Senior Biden administration officials overseeing an intelligence review into the origins of the coronavirus now believe the theory that the virus accidentally escaped from a lab in Wuhan is at least as credible as the possibility that it emerged naturally in the wild -- a dramatic shift from a year ago, when Democrats publicly downplayed the so-called lab leak theory."

Paul, an ophthalmologist, told Fauci, "We don't know that it did come from the lab, but all the evidence is pointing that it came from the lab, and there will be responsibility for those who funded the lab, including yourself."

Fauci replied, "I totally resent the lie that you are now propagating, Senator, because if you look at the viruses that were used in the experiments that were given in the annual reports that were published in the literature, it is molecularly impossible" for those viruses to result in the coronavirus.

A week after the May faceoff, Fact Checker Glenn Kessler of The Washington Post wrote, "There is some smoke here, but we do not yet perceive the fire claimed by Paul. To some extent, all money is fungible. But the . . . funding was not related to the experiments, but the collection of samples. The NIH grant includes language that some say suggests gain-of-function research; NIH says that is a misinterpretation. Paul’s statements about [Dr. Ralph] Baric’s research [with Chinese collaborators] also appear overblown. We wavered between Two and Three Pinocchios, but decided on Two, because there still are enough questions about the work at the Wuhan lab to warrant further scrutiny, even if the NIH connection to possible gain-of-function research appears so far to be elusive."

On Kessler's four-Pinocchio rating scale, two means "Significant omissions and/or exaggerations. Some factual error may be involved but not necessarily. A politician can create a false, misleading impression by playing with words and using legalistic language that means little to ordinary people."

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State reports 1,054 new coronavirus cases, raising weekly infection rate by 18% in one day; state as a whole is 'orange'

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

By Al Cross

Kentucky Health News

If there was any doubt that the coronavirus is surging in Kentucky, it was dispelled by Tuesday's daily report from the state Department for Public Health.

The state reported 1,054 new cases of the virus, the most since March 11. That raised the seven-day rolling average to 554, an 18 percent jump from Monday's figure of 470.

Kentucky's seven-day infection rate likewise jumped, to 11.5 per 100,000 residents, moving it into the "accelerated" category indicated by orange on the health department's county-level map. Nine counties were in red, reflecting seven-day infection rates above 25 per 100,000: Webster, Hopkins, Muhlenberg, Hart, Washington, Whitley, Laurel, Clay and Lewis.

Hospitalizations continued to increase. Kentucky hospitals reported 347 Covid-19 patients, 112 of them in intensive care and 44 of those on a ventilator. The intensive-care census has not been that high since May 18.

The share of Kentuckians testing positive for the virus in the last seven days rose for the 25th day in a row, to 5.71 percent.

The state reported three more deaths, raising Kentucky's pandemic toll to 7,304.

The surge is being driven by the much more contagious Delta variant of the virus and a low rate of vaccination in many places. On Monday Gov. And Beshear and Health Commissioner Steven Stack recommended that: 

• All unvaccinated Kentuckians should wear masks indoors when not at home;
• Kentuckians at higher risk from Covid-19 due to pre-existing conditions should wear masks indoors when not at home;
• Vaccinated Kentuckians in jobs with significant public exposure, such as retail and hospitality, should consider masking at work; and
• All unvaccinated Kentuckians, when eligible, should be vaccinated immediately.

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