Bill to leave children's Covid-19 vaccination decisions entirely with parents and guardians is approved by a House committee

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers have sent the House a bill to ensure that the state's children are not required to get a Covid-19 vaccine and that this decision is the responsibility of the child's parents and guardians.

The bill is designed to keep the Kentucky Department of Education from imposing the requirement by regulation, the bill's sponsor told the March 2 House Health Services committee.  

“What my fear is,” said Rep. Shawn McPherson, R-Scottsville, “is if we don’t decide that the parents or guardian is the one responsible for these children to receive Covid shots, then possibly when we get out of session, the KDE could recommend based on CDC recommendations that before kids go back to school next fall, they have to have a Covid shot.”

Kentucky Department for Public Health graph

Fewer than half of Kentucky's school-aged children are fully vaccinated against Covid-19 and this rate decreases with age. The state Department for Public Health's latest weekly report said 17 percent of the 3,289 new coronavirus cases in Kentucky were in people 18 and younger. 

The committee approved a revised bill that expanded the groups that cannot require a child to get the Covid-19 vaccination from the original bill, which only involved the education department. 

It says: "No person, entity, corporation, company, organization, or government agency, public or private, shall require or coerce in any manner any child to receive a vaccination for Covid-19 or any mutated strain of the Covid-19 virus, other than the child's parents, de facto or legal custodians or guardians." 

Rep. Rachel Roarx, D-Louisville, said she opposed the bill because government officials have a "social responsibility" to make sure people in public spaces are vaccinated against contagious diseaes.

"It's of utmost importance for us to ensure that folks are vaccinated for public-health reasons. . . . For a long time in terms of public settings and public schools, we have required vaccinations, and there are alternatives if a family member does not wish to vaccinate, that's why we have homeschool," she said. 

The committee chair, Rep. Kim Moser, R- Taylor Mill, said this bill is about parental choice.

"This in no way diminishes the value of vaccines, this just gives parents a choice in K-12 on for this specific vaccine," she said. "This is being treated much like the flu vaccine, where the variant is different every season . . . That's why we felt like it was important to give parents a choice and not mandate this." 

The committee approved the bill 14-3, with Roarx and fellow Democrats Lamin Swann of Lexington and Roarx and Lisa Willner of Louisville voting no.

The bill has received two of its three required readings and is posted for passage on the House floor Tuesday, March 7.

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Bill to exclude fentanyl test strips from legal definition of drug paraphernalia awaits initial passage by the state House

By Sarah Ladd
Kentucky Lantern

Fentanyl test strips would no longer be considered drug paraphernalia in Kentucky under a bipartisan bill that the House Judiciary Committee approved Wednesday, on a 17-0 vote with three passes.

A revised version of House Bill 353, sponsored by Reps. Kim Moser, R-Taylor Mill, and Rachel Roberts, D-Newport, is posted for passage by the full House.

It says “Narcotic drug testing products utilized in determining whether a controlled substance contains a synthetic opioid or its analogues shall not be deemed drug paraphernalia under this section,” unless the prioduct “is utilized in conjunction with the importation, manufacture, or selling of fentanyl or a fentanyl analogue.” It also says any such product with “residual or trace amounts of a synthetic opioid or an analogue thereof shall not be prosecuted as possession of a controlled substance.”

The Centers for Disease Control and Prevention says fentanyl test strips that can detect the presence of fentanyl in pills and other drugs within minutes, and thus help prevent overdoses.

But treating them as drug paraphernalia has dissuaded public agencies and groups that work with drug users from purchasing and distributing them, for fear that doing so would land them in legal trouble, says Kentucky Smart on Crime, a coalition working for justice reforms that address inequities and improve public health. Possession of drug paraphernalia in Kentucky is a class A misdemeanor, punishable by up to a year in jail and $500 fine.

Drug dealers mix fentanyl with other drugs, such as heroin, cocaine, methamphetamine and MDMA, because it takes very little fentanyl to produce a high, making it a cheaper option, says the National Institute on Drug Abuse. The risk of overdose increases when people don’t realize they’re taking fentanyl.

“Test strips and a strong education campaign are evidenced-based practices that can help stem the tide of deaths by fentanyl,” Jennifer Hancock, president and CEO of Volunteers of America Mid-states, said in support of the bill. “We can’t put people on the road to recovery if they’re dead.”

VOA noted that fentanyl played a role in 73% of the 2,250 overdose fatalities Kentucky recorded in 2021, the last year for which a total is available.The state has one of the nation’s worst rates of fatal overdoses.

Other steps people can take to lower overdose risk, according to the CDC, are:

• Keep Narcan handy.
• Do not mix drugs.
• Don’t take drugs alone.
• Find a treatment center near you at https://findtreatment.gov or call 800-662-4357.

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House health chair says anti-trans bill will worsen state's health-workforce shortage, chill doctors' dealings with young patients

Rep. Kim Moser voiced "grave concerns"
about House Bill 470. (Legislative photo)  

By Melissa Patrick

Kentucky Health News

A bill to ban gender-affirming treatment for Kentucky minors would worsen the state's health-care workforce shortage and chill family health providers who often are the first to provide mental health care for children, the chair of the House health committee said as the bill went to the Senate on a 75-22 vote Thursday.

"This proposal undermines everything that we're doing to increase our health-care workforce," Rep. Kim Moser, a Republican from Taylor Mill, told her colleagues. She told Kentucky Health News, "I just don't think that we should be in the business of legislating medical treatment."

Moser was one of three Republicans opposing House Bill 470, sponsored by Rep. Jennifer Decker, R-Waddy (Shelby County). The other opponents were Kim Banta of Fort Mitchell and Stephanie Dietz of Edgewood, also in Northern Kentucky.

Moser, a nurse by profession, warned against the bill's greatly extended 30-year window for lawsuits against a health-care provider who provides any gender-affirming care to a minor, including treatments that support gender transition. Currently, malpractice suits must be filed within one year.

"I just think that we're sending the wrong message in saying that on one hand, we value our health-care workers and we're working on legislation to improve our health-care workers situation, but on the other hand, we're imposing a 30-year statute of limitations," she said. "That sends a huge message to our health-care workers that we are going to micromanage you, we are going to insert government into the practice of medicine, and we are going to punish you if you step out of line." 

A bit earlier, as the House Judiciary Committee approved the bill 14-7, Moser said she appreciated that its latest version removed a defined list of mental-health providers from the list of providers who couldn't treat youth seeking gender-affirming care, but she said the reality is that initial mental health care often falls to a physician, physician assistant or advanced practice registered nurse, and this bill restricts what they can talk about with transgender youth.

"Eighty percent of what family practitioners and many other physicians do in their practice is address mental health," she told the House. "It's not only counselors who address mental health of their patients. Patients come in with a wide variety of situations, and their physicians need to be those trusted individuals with whom they can have a confidential conversation. . . . I think this goes too far. I think it's discriminatory. I think it eliminates parents rights."

Dr. Craig Losekamp, a Bowling Green physician, told the committee that the bill would impair his practice, because much of his transgender care involves non-transgender-related subjects. He said his patients come from as far as 120 miles away to seek care from him. 

“If this bill goes through, I won’t be able to take care of those kids, talking about those subjects that are very important to them," he said. "It doesn't even involve hormones, it means me acknowledging them and their gender identity and treating them as a compassionate human being."

Losekamp said 10 percent of children who come out to their family suffer physical violence from the family, about 8% are kicked out of their home, 10% run away, and the suicide-attempt rate for transgender people is 40%.

“These people need care, They need their respect. They need to be treated like human beings," he said. 

Later, the committee heard from a trans person who said they were "severely harmed" by a transition gided by their parents. Losekamp said regret happens with all surgeries, but the regret rate for transgender surgery is 1% while the overall rate for all surgeries is one in seven, or 14%.

“If you are going to make a bill pass that will protect that small percentage at the expense of the overwhelming majority, you are not managing harm; you are creating more harm," he said. The bill says it "may be cited as the Do No Harm Act," parroting the most-often cited part of the Hippocratic Oath.

Moser told Kentucky Health News that some have argued that if health-care providers don't break this law, it won't affect them, but she said it bill will cause a "chilling effect" in how they care for their patients, and "I don't think that it gives health-care workers who are looking to relocate or stay in Kentucky and practice medicine any comfort."

Asked why a bill dealing with a health issue wasn't assigned to her committee, Moser said she wasn't consuted about that.

In her closing remarks on the floor, she said, "I'd like to say to the rest of the world who's watching Kentucky, we are not complete Neanderthals; we are generally very thoughtful people."  

Asked later what she meant by that, she said, "I think that we should be a little more responsible in how we are treating children and families and health-care workers. . . . I think that there are [other] ways to address the problem they are trying to solve." 

She suggested that the bill be simplified to say that children under the age of 18 could not have transgender surgery, and to limit hormone therapy to those who have had extensive counseling.

Dr. Chris Bowling, a pediatrician from Northern Kentucky representing the Kentucky Medical Association and the American Academy of Pediatrics, told the committee that gender-affirming care is also supported by: the American College of Obstetrics and Gynecology, the Society for Adolescent Health and Medicine, the Pediatric Endocrine Society, the National Adult Endocrine Society, the American College of Physicians, the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry. 

“These are not things that should be decided on the basis of feelings; they should be decided on the basis of facts," Rebecca Blankenship, executive director of Ban Conversion Therapy Kentucky, told the committee.  

The panel then heard from supporters of the bill, including three physicians, two who spoke remotely. Two said that left alone, 80% to 90% of these youth will return to their biological gender after the onset of puberty, another cited a long-term study from Sweden that showed damage to children's mental health, and the third noted that a person's brain is not fully developed until the age of 25. 

Luka Hein, 21, who transitioned from female to male as a teenager, but has since detransitioned, said the medical system was not interested in treating the underlying cause of her distress, but instead, she got drugs and surgery and was put in “the pipeline that is the gender-affirming care industry,” which is “experimental.”

Rep. Jennifer Decker, R-Waddy, filed the bill. (Legislative photo)

Rep. Pamela Stevenson of Louisville asked Decker why the government was trying to become the parent to all of these children. Decker replied, "I have great compassion for the children, parents and their families who are in this situation. However, ultimately, it is our obligation to protect children from irreparable harm . . . We do not allow parents to give their children alcohol until the age of 18," nor cigarettes. 

Stevenson, the Democrat running for attorney general, said, "It's not for irreparable harm; it's because they're not like you." 

A new Mason-Dixon poll released by the Fairness Campaign, a pro-LGBTQ rights advocacy group, showed that 71% of respondents oppose laws letting state leaders overrule parents' wishes for gender-affirming care for their child. The Louisville Courier Journal reports that the poll surveyed 625 people with an error margin of plus or minus 4 percentage points.

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Opinion: Covid-19 vaccine effectiveness declines rapidly; seniors need to keep up their immunity, and we need a better vaccine

Covid-Net graph, adapted; gray area may have some delayed reporting and does not indicate trends.

Kevin Kavanagh, M.D.

By Kevin Kavanagh for Infection Control Today

I am at high risk for severe Covid-19, being 65 years or older, with additional health problems. I received my bivalent booster as soon as possible and am approaching my 6-month anniversary. I, thus, watched the CDC’s last Advisory Committee on Immunization Practices meeting with great interest regarding their recommendations for when to obtain my next booster.

Reuters reported that the committee concluded, “There is not sufficient evidence to recommend more than 1 Covid-19 booster shot a year for older people and those with weakened immune systems,” but the committee did voice some flexibility. It needs to be stressed that there was an absence or lack of data—rather than a presence of data—indicating the durability of vaccine immunity, justifying annual boosters.

There was no vote regarding the timing of booster doses, but there was nowhere near a unanimous consensus. Michael Hogue of the American Pharmacists Association said, “We want those clinicians to be able to make good decisions for the individual patient based upon their comfort and desire as long as we have safety in mind, and it is clear that we do have a very safe vaccine with our bivalent vaccine. So, I feel that flexibility needs to be put into this some way, with both older adults and people with immunocompromising conditions.”

I did not hear calls for approving a more frequent administration schedule. One committee member said those over 65 should be allowed to discuss off-label use with their physician in order to receive the booster sooner. Almost all the discussion centered on messenger-RNA vaccines, with little mention of Novavax or the urgent need for newer, more durable vaccines.

Vaccine effectiveness is an important point. Although much of the younger population received a get-out-of-hospital free card for the latest variant, senior citizens were in its crosshairs. Since May 2022, those over 75 had a higher rate of hospitalization than in the Delta surge; those 65 to 75 had about the same. Both age groups continue to be at high risk for death and disability.

However, when I saw data on effectiveness of the monovalent vaccines, the two-dose-or-more immunization that preceded the bivalent vaccine, I felt foreboding. The data showed that for those 65 years and older, the effectiveness of two or more monovalent doses at preventing hospitalizations fell to 28% in less than a year.

Among younger people, the monovalent vaccines were only 19% effective. This finding may seem paradoxical, but could be explained by the elderly leading a safer lifestyle and the possibility that immunity produced by previous infections may not have been as durable. Neither explanation bodes well for vaccine effectiveness lasting a year.

For the bivalent booster, effectiveness against hospitalization fell rapidly, from 52% at a median of 32 days to 31% at a median of 74 days (67-85 days) after the last dose. It should be noted that this effectiveness is on top of some residual immunity from the monovalent vaccine, since the monovalent vaccine was used as the reference.

Let’s face it. The results are dismal, with little durability from an immunity boost from a bivalent booster after an individual has had a monovalent vaccine. The benefit from the bivalent booster rapidly diminishes, and its efficacy in preventing hospitalizations two months after receiving the booster is poor and would be expected to be poorer in the elderly.

Is the bivalent booster worth taking? Yes, definitely. However, this differs from the booster or vaccine we need to navigate this pandemic. We need another warp-speed initiative for vaccine development—a vaccine that is more durable and can reduce spread. The risk of continuing to use a vaccine with reduced effectiveness is shown when the vaccine was seemingly less effective in the young. When vaccinated, many view themselves as invincible and can increase risky behavior far beyond the vaccine's benefits.

It is critical for the elderly to keep their immunity as high as possible. Monoclonal antibodies are no longer effective with the new variants, and far too many cannot receive Paxlovid because of drug interactions. Molnupiravir is often not prescribed since it works by creating viral mutations and has been implicated in speeding variant evolution.

At the conclusion of the CDC committee meeting, my primary impression was that we senior citizens might be viewed as expendable. Far too few policymakers are concerned about our well-being and willing to make the hard decisions that must be made to assure our safety during this pandemic. After looking at the data, I will consult my physician about receiving a booster on an accelerated schedule, possibly at six months.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA. This is an edited version of his original article, which was first published in Infection Control Today.

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Humana says it will drop commercial employer-sponsored health insurance and hopes to grow through government programs

Humana's headquarters on Main Street in Louisville

Kentucky Health News

Louisivlle-based Humana Inc., which originated as a nursing-home company 60 years ago, then became a hospital company and then a health-insurance company, is planning to transform itself again – into a compaany that offers general health insurance only through government plans: Medicare Advantage, Medicaid and the military plan.

Humana announced Thursday that it would stop providing employer-sponsored commercial coverage, including self-funded and Federal Employee Health Benefit plans, over the next 18 to 24 months. "Humana will still provide insurance through its military service business," reports Tom Murphy of The Associated Press. "It also will still provide employer-sponsored specialty coverage like vision and dental benefits."

Humana covers more than 13 million people, but fewer than 1 million are in employer-sponsored health insurance, not counting the Tricare plan for active-duty service members, families and retirees, which has an enrolment of nearly 6 million.

“This decision enables Humana to focus resources on our greatest opportunities for growth and where we can deliver industry leading value for our members and customers,” President and CEO Bruce Broussard said. “It is in line with the company’s strategy to focus our health plan offerings primarily on government-funded programs . . . ”

Half of Kentuckians on Medicare have Advantage plans, in which the federal government pays the insurer a flat fee per enrollee, creating an incentive for the insurer to limit the cost of claims. Managed-care Medicaid plans, like those Humana and other insurers have in Kentuckym, are funded likewise.

"Employer-sponsored enrollment growth has largely slowed for insurers, including market leaders like UnitedHealthcare," Murphy reports. "Companies have turned more to government-backed coverage like Medicare Advantage or Medicaid for growth. They also have pushed deeper into managing prescription drug plans and providing care in order to control health-care costs."

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With 'low confidence,' Energy Dept. says Covid-19 likely from lab; FBI confidence 'moderate;' intel panel, 4 other agencies disagree

The Wuhan Institute of Virology is located in the city where
the pandemic began. (Photo by Hector Retamal, AFP/Getty)

The Department of Energy has concluded that the Covid-19 pandemic "most likely arose from a laboratory leak, according to a classified intelligence report recently provided to the White House and key members of Congress," The Wall Street Journal's Michael Gordon and Warren Strobel report.

The department "made its judgment with 'low confidence,' according to people who have read the classified report," the Journal reports. The agency thus joins the FBI "in saying the virus likely spread via a mishap at a Chinese laboratory," the Journal notes. "The FBI previously came to the conclusion that the pandemic was likely the result of a lab leak in 2021 with 'moderate confidence' and still holds to this view. . . . While the Energy Department and the FBI each say an unintended lab leak is most likely, they arrived at those conclusions for different reasons."

Four other agencies and a national intelligence panel still judge with "low confidence" that the pandemic "was likely the result of a natural transmission, and two are undecided," the Journal reports. "The Energy Department’s conclusion is the result of new intelligence and is significant because the agency has considerable scientific expertise and oversees a network of U.S. national laboratories, some of which conduct advanced biological research."

The Journal adds, "The National Intelligence Council, which conducts long-term strategic analysis, and four agencies, which officials declined to identify, still assess with 'low confidence' that the virus came about through natural transmission from an infected animal, according to the updated report. The Central Intelligence Agency and another agency that officials wouldn’t name remain undecided between the lab-leak and natural-transmission theories . . . Despite the agencies’ differing analyses, the update reaffirmed an existing consensus between them that Covid-19 wasn’t the result of a Chinese biological-weapons program, the people who have read the classified report said."

Because no animal source for the novel coronavirus has been confiormed, and Wuhan, where the outbreak began, "is the center of China’s extensive coronavirus research, has led some scientists and U.S. officials to argue that a lab leak is the best explanation for the pandemic’s beginning," the Journal reports. "State Department cables written in 2018 and internal Chinese documents show that there were persistent concerns about China’s biosafety procedures, which have been cited by proponents of the lab-leak hypothesis."

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School officials sound the alarm about students getting sick from vaping and the threat of illegal or deadly substances in devices

Kentucky Health News map; Whitley and Knox counties reflect Corbin Independent Schools.

Harlan County school officials have "asked businesses to guard against selling vape pens to minors after students in a nearby county got sick from using vape pens that may have contained an illegal drug," and school officials in other counties have issued similar warnings, report Bill Estep and Valarie Honeycutt Spears of the Lexington Herald-Leader.

The officials' letter urged businesses "to move vaping products behind the counter and to try to make sure employees don’t sell to minors. The letter said that while most businesses that sell vape products follow the law, school officials had heard from an 'alarming number of underage students' that they had bought such products locally, illegally."

“Please help us avoid a tragedy,” said the letter, which came after incidents in nearby Knox County, "in which students suffered concerning symptoms after using vape pens" Feb. 10-16, the Herald-Leader reports. "The symptoms included shortness of breath, increased heart rate and confusion . . . Four students went to the hospital for treatment and four were treated by a school nurse," according to the Appalachian High Intensity Drug Trafficking Area, a federally funded law-enforcement unit.

"Frank Shelton, spokesman for the school district, said the district had only four incidents, not eight," the newspaper
reports. "After three students at Lynn Camp Middle/High School had adverse symptoms on Feb. 15, Knox County Sheriff Mike Smith said in a news release that the vape pens they used were believed to have contained THC, the ingredient in marijuana. AHIDTA said in its bulletin two vape pens involved in the incidents may have been laced with fentanyl."

If testing at the Kentucky State Police lab "confirm any of the vape pens in Knox County were laced with fentanyl, it would be the first time that has been documented in Kentucky, and would be among only a few cases nationwide, according to the AHIDTA bulletin." Knox County school officials told parents in letters that vaping can be risky for youth because they may not know whether electronic cigarettes contain illegal or deadly substances.

"In Harlan County, school officials told businesses that the use of vaping products by young people is a growing problem," the Herald-Leader reports. School Police Matt Chief Cope told the newspaper that students in the district have become sick from vaping, and he and Safe Schools Director Jim Whitaker visited all 20 businesses in the county that sell vape pens to deliver their request in person.

In November, the board of the Corbin Independent School Distrrict, which includes parts of Knox and Whitley counties, published an open letter saying that some students had become ill after using vaping products. "The letter said that during a talk by an expert in the subject, more than half the middle school students in the audience raised their hands when asked if they knew someone their age who vaped regularly and couldn’t stop," the Herald-Leader reports, citing the News Journal, a Corbin newspaper.

The problem isn't just in southeastern Kentucky schools, the Herald-Leader notes: "After Kentucky State Police used dogs to do a surprise search for illegal substances at Edmonson County High School last month, the principal, Jonathan Williams, said local officials were finding that illegal substances were being sold in vaping products. . . . Earlier this month, the sheriff in Lyon County said a 14-year-old girl was facing charges after she was found with a vape device that contained THC, the chemical in marijuana. The case arose after school officials told police about getting a report that students were vaping on a bus, according to WPKY."

Surveys by the state Department of Education show that the share of middle-school students reporting frequent vaping, defined as 20 days out of the last 30 days, rose from 1.4% in 2015 to 2.9% in 2021, "and the number who said they had ever vaped rose from 21.8% to 24.1% in the same period," the Herald-Leader reports. "Among high-school students, the number reporting frequent use rose from 3.2% in 2015 to 8.1% in 2021, and the percentage who said they’d ever used a vaping product increased from 41.7% to 45.1%."

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