Positive-test rate, 7-day new-case average set new records in Kentucky; more than one-fourth of new cases are in children

Ky. Health News graph; cases are from initial, unadjusted state reports. (Click on it to enlarge.)

Kentucky Health News graph; click to enlarge.

By Melissa Patrick

Kentucky Health News

The Omicron variant continues to rage through Kentucky, with nearly one in three Kentuckians testing positive for the coronavirus and 26 percent of Wednesday's new cases among those 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days rose about half a percentage point Wednesday to 30.77%, a new record.

Kentucky reported 12,583 new cases of the coronavirus, the third most on a single day. That raised the seven-day rolling average by nearly 200 daily cases to another record, 10,765. It's 88% higher than it was 14 days ago.

More than a fourth of new cases, 3,320 (26.4%), were in Kentuckians 18 and younger.

As cases among Kentucky's children increase, there's still a lot of opportunity to get more of them vaccinated. Only 50% of 16- and 17-year-olds, 47% of those 12 to 15, and 19% of those 5 to 11 have received at least one dose of a Covid-19 vaccine. And research shows that immunity against Omicron requires three doses, including a booster shot, of the Pfizer or Moderna vaccines.

The latest American Academy of Pediatrics weekly Covid-19 report says that Covid-19 cases among children have "spiked dramatically" across the United States, with nearly 1 million cases reported in the week ended Jan. 13, four times the rate of the peak of last winter's surge.

"This number is a 69% increase over the 580,000 added cases reported the week ending January 6th and a tripling of case counts from the two weeks prior," says the report.

Recent guidelines from the Centers for Disease Control and Prevention, updated Jan. 13, say "high risk sports and activities" should be canceled or held virtually in areas with high levels of coronavirus transmission "unless all participants are fully vaccinated." High-risk activities include sports that require close contact as well as those that involve "increased exhalation," like singing, shouting, band or vigorous exercise, especially when conducted indoors.

Bu far, every county in Kentucky has a high level of virus transmission, defined as more than 25 cases per 100,000 residents. The statewide infection rate is 217.3 daily cases per 100,000. Five counties are above 300 cases per 100,000: Carroll, 392.4; Warren, 324.7; Henderson, 317.2; Fayette, 306.2; and Simpson, 302.3.

The New York Times ranks Kentucky's statewide rate 18th among the states, a jump of 26 slots from Tuesday, when it ranked 44th.

Kentucky hospitals reported 2,256 Covid-19 patients Wednesday, 56 more than Tuesday. Of those, 455 were in intensive care, up 24; and 252 were on mechanical ventilation, up 8. 

Nine of the state's 10 hospital readiness regions continue to use at least 80% of their intensive-care beds, with five of them above 90% and Northern Kentucky at 100%.

The state attributed 25 more deaths to Covid-19, bringing Kentucky's pandemic death toll to 12, 639.

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Map shows your county's rate of deaths from Covid-19

Kentucky Health News map, from state Department for Public Health data; click on it to enlarge.
For clarity, rates above 415 deaths per 100,000 residents are rounded to the nearest whole number. 

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Omicron keeps setting records; tests are over 30% positive, not counting home tests; hospitals adopt crisis standards for staffing

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

By Melissa Patrick
Kentucky Health News

As the Omicron variant of the coronavirus continued to set new records in Kentucky and Covid-19 hospitalizations accelerated, some hospitals moved into what is called "crisis standards for staffing."  

Kentucky reached a new high for the number of Covid-19 cases reported in a Monday-to-Sunday reporting week, 72,165. That's more than double the records set during the Delta surge, said Gov. Andy Beshear.

On Saturday, the state reported 14,896 reported new cases, a record for one day. More than 1 million Kentuckians have had a confirmed case. Of today's 8,742 new cases, 27.76% were in people 18 and younger.

Another record: the share of Kentuckians testing positive for the virus in the past seven days hit yet another, 30.25%. "We never dreamed that almost one out of every three people being tested would be positive," Beshear said. 

Those numbers do not include any at-home tests, and the case numbers do not indicate any positive test results, which may not be accompanied by symptoms.

The state's daily report was the first since Friday, due to the Martin Luther King holiday. The seven-day rolling average of new cases surged to a record 10,673 on Monday but dropped slightly Tuesday, to 10,572.

The statewide daily incidence rate is 213 cases per 100,000 residents. The rate in 41 of the state's 120 counties is above 200 cases per 100,000, and every county has more than 25 cases per 100,000, considered a high level of transmission, putting all of them in red on the state infection map. 

Despite the big increases, most other states are in worse shape. The New York Times ranks Kentucky's rate 44th among the states, with a 47% increase in cases in the last 14 days. 

Dept. for Public Health graph, adapted by Ky. Health News

But hospital numbers continue to go up, causing some to instigate "crisis standards for staffing," which give them to have latitude for bringing staff back from quarantine or isolation. Health Commissioner Steven Stack said more than 450 National Guard members continue to support the state's health-care facilities. 

"It is a tough time to work in a hospital," Stack, an emergency-room physician, said as he thanked them for their service.

Hospitals reported 2,200 Covid-19 patients on Tuesday; 431 of them in intensive care and 244 on mechanical ventilation.

Recently, public-health experts in major cities have noted that many patients with Covid-19 were admitted with other conditions but were identified as such after they tested positive for the virus, Beshear said hospitals are not breaking down those patients into different categories. 

Asked about the U.S. Supreme Court's decision that allows the federal government to require vaccination of employees at health-care facilities that get federal money, Beshear said he expects very few workers in such facilities to refuse vaccination, so it should not have any significant impact on their workforces. 

Nine of the state's 10 hospital regions are using at least 80% of their intensive care beds, and five of them are above 90%. Northern Kentucky is at 100%. 

With hospital capacity so stretched across the state, Beshear again encouraged Kentuckians to get vaccinated. "Get vaccinated, get boosted and you're very unlikely to end up in the hospital for Omicron," he said. 

Three-fourths of of Kentuckians 18 and older have received at least one dose of a vaccine, but health experts say three doses of the Pfizer of Moderna vaccines, including a booster shot, are needed for Omicron immunity.

Both the percentage of adults and children 5-11 who have been vaccinated increased by one percentage point recently, but only 19% of those children have had a shot, With schools reopening, Beshear said, "We have to do better." 

So far, 2.8 million Kentuckians have gotten at least one dose of a Covid-19 vaccine, or 63% of the total population; 2.4 million are fully vaccinated, or 55% of the total. Among the fully vaccinated population, 959,754, or 39%, have been received a booster shot.

In yet another push for shots as a way to stay out of the hospital or to have less severe symptoms,  Beshear said, "If you are unvaccinated, it hits you like a Mack truck and we see people in the hospital and dying from Omicron because of that failure to get vaccinated."

Addressing unvaccinated people who think they can get monoclonal-antibody treatment if they get sick, Stack said there is not enough of the anti-viral medication available to meet demand. 

"The bottom line is that you can't rely on finding these medications reliably, no matter how we distribute them, and this won't change before the Omicron surge recedes," Stack said. "Vaccines though remain abundant and are highly effective in preventing severe and life-threatening disease." 

Stack noted President Biden’s plan to make 1 billion at-home tests directly available to the public. You may order four at-home tests per household at COVIDtests.gov.

Besehar said 294 state prison staff and 392 inmates have tested positive in the current outbreak but no inmates have been hospitalized. He said the Eastern Kentucky Correctional Complex, the Kentucky State Reformatory and the Kentucky Correctional Institution for Women have been quarantined and 85% of all inmates have been vaccinated, with 55% of them boosted. 

Beshear also listed state veterans' centers with cases: one at the Eastern Kentucky Veteran Center, one at Radcliff Veterans Center; two at Thompson-Hood Veterans Center in Wilmore; and five cases at Western Kentucky Veterans Center. 

Beshear said he had not heard of any outbreaks in Kentucky nursing homes. 

The state has reported 131 more Covid-19 deaths since Friday, with one of the deaths a 28-year-old, three of them in their 30s, and 10 of them in their 40s. The pandemic death toll in Kentucky is 12,614. 

"If you are in your 40s, this thing is killing you right now," said Beshear. "Please get vaccinated."

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13% more Kentuckians used prescription drugs for mental health in October than in January, as the pandemic added to stresses

Quote Wizard map, adapted by Ky. Health News, shows increases in adjoining states and Southeast.

By Melissa Patrick

Kentucky Health News

Kentucky is one of 28 states that saw an increase of more than 10 percent in the number of adults taking prescription mental-health medications last year, which is largely attributed to the prolonged impact of the pandemic, according to an analysis of Centers for Disease Control and Prevention data. 

"Covid-19 hasn’t just affected people’s physical health. The pandemic has also had a profound and prolonged impact on people’s mental health. Over the last year, more and more people have reached out for help dealing with stress, anxiety or depression," says the report from Quote Wizard, based on Pulse survey data from the Centers for Disease Control and Prevention from January 2021 to Oct. 15, 2021.

The figures show that 29% of Kentucky adults are taking prescription mental-health medications. That amounts to about 1 million people, 13% more than in January 2021.

Kentucky's rate of increase was less than the national increase of 20%, but the percentage of Kentucky adults taking prescription mental-health drugs remains above the national rate of 24%.  

Sheila Schuster, a psychologist and executive director of the Kentucky Mental Health Coalition, said she was "delighted" to see more Kentuckians seeking mental-health care, especially during the pandemic, when every age group is struggling with issues that exacerbate anxiety and depression. 

"I think Covid has had potentially devastating effects on the mental health of all ages in Kentucky," Schuster said. "So I'm delighted actually to see that there has been an increase in contact with mental-health providers. . . . You know, we really want people to reach out, to get some help before things get into a state of multiple, serious mental-health concerns."  

Schuster pointed out some challenges brought on by the pandemic: feelings of not being in control, economic uncertainty, social isolation, remote learning challenges, a shutdown of peer-support services for people with substance-use disorder, and an uptick in domestic violence. Add to that, she said, the racial tension sparked by the Breonna Taylor case in Louisville and the natural disasters that have plagued several other parts of Kentucky. 

"Some people are really dealing with what must feel to them like an unbearable amount of stress and grief and loss compounded with this anxiety and depression so, you know, our message has been over and over to reach out for help," she said. 

What is often most effective, particularly for more serious stages of depression or anxiety, Schuster said, is a combination of talk therapy with some medication. To that end, she said the Kentucky Mental Health Coalition, Mental Health America Kentucky and the Kentucky Psychological Association have been writing op-eds and holding public forums to alert people that what they are feeling is not unusual and to encourage them to reach out for some additional help if they need it. 

"I think actually we're going to be seeing the aftermath of Covid for the next four or five years," she said.  

MHA Kentucky Executive Director Marcie Timmerman said MHA has seen a significant increase of interest in mental health and wellness during the pandemic, noting a 265% increase in voluntary mental-health screenings from 2019 to 2021, with 4,770 screenings in 2019 and 17,419 in 2021.

"It makes sense to me, with the increase in talking about mental health that has accompanied Covid-19, that we see an increase in forms of treatment like medications," Timmerman said. 

MHA ranked Kentucky 23rd for prevalence of mental-health illness in 2021, based on six mental-health measures that included both youth and adults. 

Timmerman encouraged Kentuckians to keep talking to their health-care providers about their mental health, and reminded providers to remember "that prescriptions are most effective when paired with therapy."

Schuster added that other than your family doctor, ministers, friends who use mental health care, professional mental-health organizations, like MHA, and community mental-health centers, which serve every Kentucky county, are also good resources to help you find mental health care providers in your area. 

The report notes that most insurance plans cover some form of mental-health care, including Medicare and all Affordable Care Act plans. 

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Feds say Covid-19 home tests will ship directly to users starting Wed., same day they plan to put online the website to order them

The Biden administration says it will begin mailing Covid-19 tests directly to Americans on Wednesday, Jan. 19. That's also the same day it plans to put online the U.S. Postal Service website where they can order the tests.

Administration officials "did not state a specific time on Wednesday when orders could begin," Kelly Lienhard of Inside Health Policy reports. "The officials said the government currently has over 420 million tests under contract and they are confident the government will be able to procure the remaining 80 million by Wednesday." The estimated cost is $4 billion.

The tests are rapid at-home tests that have been granted emergency-use authorization by the Food and Drug Administration. Federal studies "have confirmed the tests can detect the Omicron variant," Lienhard reports.

"Americans can expect to receive the tests within seven to 12 days of placing an order through the website. The government is working with USPS to ship the tests for free to all 50 states and U.S. territories through priority mail. Administration officials said they projected the timing based on typical shipment times, but they anticipate it will be quicker as the program matures."

Orders will be limited to four tests. "Administration officials stressed that the Covid-19 test mailing initiative is only part of its testing strategy and added that there are myriad other ways to be screened for the virus, including through pharmacies and community health centers," Lienhard reports.

President Biden announced Thursday that he had directed the government to procure 500 million more tests. Republican Maryland Gov. Larry Hogan said on CBS's "Face the Nation" Sunday that the federal government was "hijacking" supplies of tests that had been ordered by Maryland and other states.

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The world will probably wind up living with the coronavirus, but that approach poses risks, some medical experts warn

"Nations around the planet are making a subtle but consequential pivot in their war against the coronavirus: Crushing the virus is no longer the strategy," reports Joel Achenbach of The Washington Post. "The phrase often heard now in the United States and many other nations is “live with the virus.” That new stance is applauded by some officials and scientists, and welcomed by people exhausted with the hardships and disruptions of this global health emergency entering its third year.

"But there are also disease experts who fear the pendulum will swing too far the other way. They worry that many world leaders are gambling on a relatively benign outcome from this omicron variant surge, and sending messages that will lead people who are normally prudent to abandon the social distancing and mask-wearing known to limit the pathogen’s spread. Epidemiologists say the live-with-it strategy underestimates the dangers posed by omicron."

The consensus among experts is that "Omicron is essentially unstoppable but of limited threat to individuals even as it causes societal chaos," Achenbach reports. "Ali Mokdad, an epidemiologist at the University of Washington’s Institute for Health Metrics and Evaluation, said he believes that about half of the U.S. population will be infected with omicron during the next three months, with most cases asymptomatic." But it will keep sickening and killing people.

The coronavirus has killed more than 5.5 million people, including 850,000 Americans and 13,500 Kentuckians, but the virus and the Covid-19 disease it causes "are now so familiar, they have lost some of their early spookiness," Achenbach writes. "Many nations continue to impose mask requirements, vaccination mandates and travel restrictions, but few leaders in democratic societies have the political capital to take harsh measures to suppress transmission."

So, in the absence of further prevention, what can we expect?  "In the ideal scenario, omicron’s alarming wave of infections will spike quickly, leaving behind a residue of immunity that will keep a broad swath of the population less vulnerable to future infections," Achenbach writes. "This would be the last major, globally disruptive wave of the pandemic. The virus would still be around but would no longer be in a special category apart from other routinely circulating and typically nonfatal viruses such as influenza."

But ideal scenarios often involve wishful thinking. Scientists don’t know how long immunity from having omicron will lasts, and "The virus keeps mutating," Achenbach notes. "Slippery variants packing a more powerful punch could yet emerge, and virologists say that, contrary to what has sometimes been conjectured, viruses do not inexorably evolve toward milder strains."

Some of the doctors "who advised President Biden during the presidential transition have urged a reset of the strategy to recognize the 'new normal' of the virus, which has little chance of being eradicated and will probably continue to cause typically mild illness and require vaccination boosters at a frequency yet to be determined," Achenbach reports.

But others say that approach has risks. James Lawler, co-director of the University of Nebraska’s Global Center for Health Security, told Achenbach, “If we just completely let everything go and allow the omicron epidemic to run its natural course, we’ll completely overrun our health system and be left in a situation potentially worse than what we experienced in early 2020.”

Lawler worries about the lack of precautions among the public. "Earlier this week, he went to a grocery store and was virtually alone in wearing a mask," Achenbach reports. "That’s the norm, he said, in Omaha." Lawler said, “We should have learned by now the only way to get high levels of compliance like this is to make it mandatory. That’s what happened with seat belts.”

Around the world, Achenbach writes, "There is fatalism mixing with pandemic fatigue and, in some countries, science denial or ideological rejection of the restrictions and mandates that many public-health experts consider to be common sense measures in a pandemic. And anecdotally, people may rationally feel the battle is lost, the virus has won.

"Public health officials warn that this is a dangerous attitude. It’s true that for an individual, risk might be low. But when a virus spreads as quickly as omicron does, the equation suddenly spits out alarming results — millions of people sick at once, many of them with underlying conditions that have already put them on the edge of a cliff and vulnerable to a shove."

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As Covid-19 cases spike, guidelines for people with cancer receive significant upgrades

Photo illustration from Beth Israel Deaconess Medical Center

The National Comprehensive Cancer Network has published significant updates to the expert consensus recommendations on vaccination and pre-exposure measures of Covid-19 in people with cancer. The updated guidance includes information on the preventive use of human monoclonal antibodies in addition to the following principles:

• Patients with cancer should get fully immunized, including third doses and/or any approved boosters.
• There is a strong preference for mRNA vaccines, such as the Pfizer or Moderna vaccines.
• Vaccination should be delayed for at least three months following certain cancer treatments. Vaccine delays in patients with cancer should also include those recommended for the general public.
• Full vaccination is also recommended for caregivers, household/close contacts, and the general public.
• The committee strongly supports full vaccination mandates for healthcare workers.

“All of us are called to do everything we can to save as many lives as possible during the ongoing pandemic,” said Robert W. Carlson, CEO of the National Comprehensive Cancer Network. “Vaccination is our most effective approach for avoiding serious Covid-19 complications, including hospitalization and death. However, research shows many immuno-compromised people develop inadequate immune responses from vaccines." 

Carlson mentioned additional tools to help people with cancer and others who are immuno-compromised. For example, the Food and Drug Administration has issued an emergency-use authorization for a drug combination for pre-exposure protection from Covid-19 in adults and children, starting at age 12, who have moderate to severe immune compromise and may not be responsive to vaccination.

“The medical and scientific community’s response to the Covid-19 crisis continues to be extremely encouraging, even in the face of setbacks like new variants and surging infection rates,” Carlson said. “Rapid research, thoughtful analyses, and tireless care delivery is allowing us to save so many more people than we could have a year ago. We hope by sharing this simplified guidance highlighting the latest research and approvals, we can help make sure the very latest in evidence-based care reaches as many patients and providers as possible.”

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