Here are key takeaways from KET’s May 15 program on the spread of coronavirus-19 disease, called COVID-19, in Kentucky. The show examined public health requirements for opening businesses and allowing social activities in the state and how rural community health care workers are responding during the pandemic. Dr. Wayne Tuckson also interviewed the medical director of a COVID-19 ward at a Louisville hospital.
Taking a Cautious Approach to Reopening Kentucky
Dr. Steven Stack, MD, Kentucky’s public health commissioner, says that state government is moving forward with a phased re-opening of Kentucky’s businesses and social activities, called Healthy at Work, that started earlier this month.
Dr. Stack estimates that only 5 percent of Kentuckians have been infected with the coronarivus through mid-May. He urges people to be vigilant about wearing masks when out in public and also to maintain social distancing, as those are two steps every citizen can take to help keep themselves and those they interact with safe. He says that instead of trying to enforce these guidelines, his office seeks to inspire people to empower themselves and adopt a public-service mindset.
“It’s never really been about coercion,” he says. “We’re going to have to rely on Team Kentucky to come together and do the right thing.” He advises viewers to be aware of their surroundings when venturing back out into society, and to avoid interacting with folks who choose not to wear masks and practice social distancing.
Other businesses and activities are slated to resume in June or July if pubic heath officials are confident that the spread of coronavirus in Kentucky is declining. “We’re going to watch the number of new cases we have on a daily basis and over a multi-day basis,” Dr. Stack says, “We’ll pick a multi-day average and look to see if there’s an uptick. Of course, if we start to see an increase in deaths, that would be another indication.”
Dr. Stack acknowledges that Kentuckians are anxious to return to normal activities, but cautions that the virus will affect society for many months to come, since a vaccine won’t be ready until next year at the earliest and there is currently no proven treatment for COVID-19. He refers viewers to the state website at kycovid.19.ky.gov for a set of guidelines to help folks plan their summer, which are based on recommendations from the Centers for Disease Control and President Donald Trump’s Coronavirus Task Force.
“We’re being very pragmatic and practical about this,” he says. “The public is demanding a return to engagement. From a public health standpoint, I’m very worried, I’m very scared about this return to people coming together… On the other hand, I’ve never been cavalier about the severity of the economic consequences.”
As part of the Healthy at Work schedule, restaurants in Kentucky are slated to re-open on May 22 at 33 percent capacity except for outdoor seating, which can be more populated if distance requirements are met. Dr. Stack says that he’s concerned about restaurants opening back up since gathering indoors carries a higher risk of transmitting the coronavirus.
“I think they’re going to have to thin a lot,” he says. “Ask people sitting at a table to be of a family unit or a group, the same household ideally. We’re going to have to ask people to be very, very careful, and it is going to be challenging. We’re going to ask people to wear masks – certainly the wait staff when they’re working.”
How Rural Health Care Workers Are Responding
According to the Kaiser Family Foundation, 49 percent of Kentuckians live in rural areas, much higher than the national average of 19 percent. Frances J. Feltner, DNP, director of the University of Kentucky Center of Excellence in Rural Health, says that rural citizens in Kentucky were already dealing with high rates of chronic diseases such as diabetes, heart disease, and cancer prior to the COVID-19 pandemic.
Doctors, and hospital and clinic staff, and community health workers in rural counties had to suspend much of their practice for several weeks along with the rest of the medical community, Feltner says, but they still reached out to folks during that time to offer assistance, and are continuing to do so as restrictions on office visits and procedures are lifted.
Part of that assistance is educating the public about best practices for preventing COVID-19 infection, and just checking in.
“The elderly population has a fear about being in a crowd or actually going to the grocery store or the post office, and without information are kind of trapped in their homes,” Feltner says. “Some of the community health workers have said that just talking to them is really helpful, because depression sets in when you have social isolation and you’re getting bad news all of the time, and sometimes you need a mental health break.”
Rural patients with chronic diseases still need their medications during the pandemic, Feltner explains. She says that community health workers have helped folks fill those prescriptions, working with pharmacies to set up mail or at-home deliveries. They have also coordinated with food banks to help patients whose income has been affected by the pandemic.
“Over the years, I’ve told people that I have found the missing link,” Feltner says. “And the missing link is the community health worker. The community health worker links the provider to the patient they’re serving, it links the patient back to that provider and to the needs that they have.”
A Report from the COVID-19 Front Lines
Dr. Valerie Briones-Pryor, MD, is the medical director of the Hospitalist Program at University of Louisville Health. She and her team have treated many the patients diagnosed with COVID-19 in recent weeks, and she says that the patients have presented with a variety of symptoms that have been commonly associated with the disease, including shortness of breath and fever.
“But as I’ve been doing this longer, I found out it could be really any symptom,” Dr. Briones-Pryor says. “I’ve had patients who’ve presented with gastrointestinal symptoms. Initially we thought COVID-19 was primarily a pulmonary disease, but we’re seeing folks coming in with nausea and vomiting, they have a fever or no fever, and they test positive for COVID. Their oxygen saturation will be completely fine and they won’t even complain of shortness of breath.”
Dr. Briones-Pryor’s staff treats only adult patients, and the medical director says that the age range has spanned the gamut from young adults to senior citizens. “A lot of them have been healthy, and some have had co-morbidities, so what I realize about this virus is that it doesn’t care,” she says. “It affects everyone – it doesn’t matter if you’re healthy, it doesn’t matter if you have chronic medical problems. We’ve seen it all on this floor.”
Dr. Briones-Pryor explains that her ward coordinates patient care with the intensive care unit at U of L Health since patients with COVID-19 can deteriorate fast. She adds that protocols for treating patients are developed in collaboration with infectious disease experts and are constantly evolving as researchers learn more about how the virus affects the body.
The past two months have been very challenging, and workers in the COVID-19 ward have made many sacrifices working away from their families for long periods of time. But the crisis has only strengthened their commitment to helping patients, Dr. Briones-Pryor says.
“It’s been emotionally draining, not only for me but for our nursing staff as well,” she says. “But we all take care of each other – we’re a big team up here on the unit, and we try to take care of patients and take care of each other.”
