Here are key takeaways from KET’s April 3 program on the spread of coronavirus-19 disease, called COVID-19, in Kentucky:
Answers to New Viewer Questions About COVID-19
- What guides Kentucky’s public health department in making decisions about preparations, interventions, and restrictions for Kentucky’s citizens to help stop the spread of COVID-19?
“We use a lot of different sources of data,” says Dr. Steven Stack, M.D., Kentucky’s public health commissioner. “Of course, we use the own data we collect from our own laboratory testing here in the state, and I’m in communication on a regular basis with local health department directors and also with leadership at hospitals around the state. On top of that, we use information that’s publicly available.”
Dr. Stack says that his department and other leaders in the public health sphere are working with a data set that is constantly changing due to the fact that this is a novel coronavirus and its effects on humans are not fully understood. “It really requires a fair amount of educated interpretation of a lot of varying, different data sources,” he says.
- A projection of COVID-19 deaths in the U.S. by the University of Washington forecasts a peak in deaths in the nation on April 16, but also forecasts a later peak in Kentucky of May 15 with total deaths per capita lower than many states. How does that correlate with the state health department’s own predictions?
“I’m real proud of us in Kentucky, and I mean that for the governor’s decisions,” Dr. Stack says. He explains that while Gov. Andy Beshear’s actions to close non-essential businesses and prohibit group gatherings in the commonwealth were difficult, they have helped “flatten the curve” of coronavirus infections, hospital admissions, and deaths and therefore ease the strain on the state’s health care system.
“On the flip side, it’s difficult to calibrate the message,” Dr. Stack adds. “Because people hear the good news, and we worry that they’re going to stop taking seriously the warnings…. This disease is a real bad actor, so we have to do these steps and we have to keep the pressure up.”
Dr. Stack also observes that most states surrounding Kentucky have reacted to the coronavirus spread later and with less restrictive orders. He says that puts Kentuckians at risk if they travel to those states in the coming weeks and then return and bring the virus back to their communities.
“It’s time to stay healthy at home for the next couple of weeks so we can see where this goes and keep everyone well,” Dr. Stack says.
- Research has proven that persons who have COVID-19 but are asymptomatic can still spread the disease, and new reports suggest that virus particles can be transmitted through conversations between persons in close contact. How do these findings affect state officials’ recommendations about wearing masks?
“For me, it doesn’t change the recommendations,” Dr. Stack says. “We’ve talked about the secretions from your mouth and nose are the most common way the disease can spread – possibly not the only way, there could be other ways.” Secretions may spread most commonly through coughing and sneezing, he says, but talking, singing, laughing or any other action can also push the virus out into the air.
“It’s a lot more complicated about the mask guidance,” Dr. Stack cautions. “First of all, don’t be using medical grade masks just randomly walking out in public. We’ve got health care workers who are really in harm’s way and who need those masks.” He advises anyone who has surgical grade masks to donate them to Kentucky’s medical care providers.
“People ask, ‘Well what about a sewn mask, or a cotton mask, something from home?’ That’s kind of complicated,” Dr. Stack says, “because it doesn’t really make a great barrier preventing things from getting into your respiratory tract, but it may help minimize to some extent you spreading the infection to others. So I think you’ll see the guidance will continue to evolve on that, but I think we’re not being honest if we don’t acknowledge that the guidance has limitations.”
- People still compare the death rate from COVID-19 to the flu. How can I best explain to people that it’s much worse?
“COVID-19 seems to be more contagious than the flu,” Dr. Stack says. “It spreads more easily, so one person may infect three people instead of one person infecting one and a half people.... On the other side of this, COVID-19 is more dangerous than the flu.”
While influenza has a mortality rate of around .01 percent, Dr. Stack explains that conservative estimations for COVID-19 are a 1 to 2 percent mortality rate. “We’re trying to balance this for folks,” he says. “Eighty percent of people are going to be just fine, and maybe 25 percent of people have no symptoms. But if you are in the 20 percent who are at high risk, this disease can hit you hard, and it may be 10 to 20 times more dangerous than the influenza virus.”
- If you contract this coronavirus and you recover, can you contract it a second time?
That’s a question the medical community doesn’t have an answer for yet, Dr. Stack says. “Some early signs where they’re doing testing seem to imply that there’s some immunologic response, and that’s cautiously hopeful that we can develop an immune response to it. But like influenza, this virus may mutate, so there’s a lot left to learn about whether we are protected after we get it.”
- Will Medicaid, which was expanded to include more Kentuckians during the administration of Gov. Steve Beshear, be expanded even further to cover more people as a result of this health crisis?
Dr. Stack says that Gov. Andy Beshear has already ordered a 90-day extension for persons already on Medicaid, meaning that recipients don’t have to reapply or submit eligibility criteria again during this time. He adds that the governor and his administration are pursuing additional Medicaid waivers that would enable more Kentuckians to qualify for health coverage. “I would continue to pay attention to the governor’s announcements and hear what he has to say as he continues to take more steps to use Medicaid to help the vulnerable patients,” he says.
- What is the plan for mobile testing across the state? Will it be done by an independent agency or by local public health workers?
Dr. Stack says that one of the main problems keeping the state from ramping up testing is a scarcity of materials. “Even simple things like nasal swabs are hard to get, and the prices have escalated dramatically,” he says. Currently, Dr. Stack and his department are exploring possibilities of starting drive-through testing once materials are procured, and are also working with hospitals to increase testing done on site.
“But here’s my message,” Dr. Stack adds, “and this is important: If you are well, you do not need a test. If you don’t have any symptoms, please don’t seek a test, you are wasting a test that someone else needs. If you are mildly ill but are doing fine, assume you have the coronavirus and just stay home, isolate yourself, and recover. The people who need the test right now are people who are really sick, and health care workers and first responders who get sick because of their exposure.”
- Is it possible that the coronavirus spread will die down and then come back in the fall?
“That, too is a question we don’t know the answer to,” Dr. Stack says. “The influenza virus is sensitive to heat and humidity, so in the summer months it kind of calms down and goes away, and then it comes back when the temperatures get cooler in the fall and winter. We don’t know that for the coronavirus yet, we have to wait and see.”
Dr. Stack cautions that even if the coronavirus spread does decrease in the summer months, if persons prematurely begin to congregate again and don’t heed public health warnings about social distancing, it can surge back.
- Once the COVID-19 pandemic is over, what will the new normal look like?
“Nobody knows,” Dr. Stack says. “I do think that after this though, as a society we should all have learned that hand hygiene is important, that covering your cough is important, and doing those things we can do to reduce any respiratory infection is really important – whether it’s the coronavirus, the flu, or any other infection.”
What Hospitals Are Doing to Prepare for a Surge in Patients
The University of Louisville Health system has considerable experience in preparing for disasters, from coordinating responses to weather events to establishing procedures to treat patients in case of an accident or act of violence that could result in mass casualties. But the COVID-19 pandemic has brought forth an entirely new set of challenges, says Dr. Jason Smith, M.D., chief medical officer for University of Louisville Health.
“Most of the time when you’re talking about disaster planning you’re talking about a number of days to weeks, and you rely on areas that aren’t affected by that disaster to supplement what you have and your capabilities,” he says. “We don’t have that. So this is very much taking those plans, scaling them out to months, and realizing that there’s no off-loading. Because you are the facility that’s going to off-load for everyone else.”
The U of L medical system is preparing for a higher number of patients with COVID-19 to require admission in the coming weeks, and relying on data projections that Dr. Smith says “are all over the place.” He explains that a lot of the uncertainty is based on the fact that widespread testing for the coronavirus is still not available in Louisville and throughout Kentucky.
“What we are doing is planning for the absolute worst,” Dr. Smith says. “We’re taking all of our scenarios – we hope for the best, and we look at some of the epidemiological studies that say we are going to be okay – but then we take the ones that say it’s going to be an absolute disaster, and we plan for those.”
Based on those projections, Dr. Smith says U of L Health is working to increase bed capacity and planning to maximize its staff performance by creating care teams to work in shifts in the intensive care unit.
U of L Health is a tertiary care facility, meaning that it performs services for patients from other hospitals, clinics, and primary care providers as well as for its own patients. Dr. Smith says that he is holding two to three calls per week with his colleagues at Norton Health Care and Baptist Health Louisville. He adds that his team has also started to contact smaller hospitals in central and western Kentucky to establish lines of communication and offer resources to those areas when they see a surge in patients.
These hospitals “serve a phenomenal function for us and reach out to parts of our population that would be underserved otherwise,” Dr. Smith says. “We have a lot of insight into having relationships with these hospitals based on trauma, based on the role we serve in the community not just for Louisville but really the whole western part of the state and southern Indiana. So we can use those relationships and go to them and say, ‘What can we do to provide you help now?’”
Dr. Smith says that the U of L Health system currently has enough personal protective equipment (PPE) such as masks, face shields, and gloves to treat its COVID-19 patients. He adds that U of L began practicing protective equipment conservation very early when the disease was first detected in Kentucky. “Reusing masks, reusing some of the things that don’t need to be thrown away after usage, using the same item on the same patient,” he says.
Challenges Helping the Homeless During the Crisis
In normal times, the homeless face many hardships, and the ongoing spread of COVID-19 has affected the level of service organizations such as St. John Center for Homeless Men in Louisville can provide to folks in need of a place to shelter and receive assistance.
The St. John Center operates out of a former church and usually has chairs and tables for 55 individuals. Maria Price, executive director at St. John, says in a taped segment that the COVID-19 pandemic has forced staff to cut down space so it only accommodates 24 persons at once. In addition to providing a day shelter for homeless men in Louisville, the St. John Center provides a variety of services such as counseling and job and housing placement with the goal of moving persons toward self-sufficiency.
But Price says that she has had to reduce those services considerably. Over the past few weeks, St. John Center is only providing showers to its visitors and mail service.
“Last year, we averaged 167 visitors a day,” Price says. “Alarmingly, the number of visitors has not dramatically decreased even though our seating capacity has been cut by more than 50 percent.”
The St. John Center operates with the assistance of 17 volunteers per day, but they were requested to stay home during the pandemic. Price says that she and staff members who are at the center are doing their best to help their visitors as much as possible, but adds that just in the past week, five staffers started exhibiting symptoms of COVID-19.
“One problem that has arisen is that many of the clothing giveaway ministries have had to close for safety reasons, and so the folks we see have been in their same clothes for about three weeks,” Price says. The St. John Center is able to offer new socks and underwear for free to its visitors, she adds.
Price says that the men who visit St. John Center are showing signs of heightened anxiety due to the reduction in services and the overall sense of disruption to their daily routine and uncertainty about the future. “Like any of us who feel like we have so few options, you feel stuck between a rock and a hard place, and the clients do as well. That brings along feelings of grief and loss,” she says.
Two men assisted at St. John Center were able to move into their own housing over the past week, Price says, but she adds that overall, appointments for housing options have been dramatically reduced, as have government office hours.
“The clients know that they will be stuck in homelessness even longer than they had originally anticipated,” Price says. “What concerns me the most right now is trying to imagine six, nine, 12 months from now when we know we will have a dramatic increase in the number of people who need us, and yet a harder and harder time to raise the funds that we need to sustainably meet our mission.”