For weeks now, Gov. Andy Beshear has warned Kentuckians that the number of coronavirus cases in the commonwealth would increase. And each day they do, sometimes by a small amount, sometimes by the dozen.
“The good news, though, is that the numbers are going up much more slowly than they might otherwise,” says Kentucky Public Health Commissioner Dr. Steven Stack. “The measures we’ve taken... we believe are having the desired effect.”
The commissioner says Kentucky benefitted from Beshear’s early and aggressive actions to contain the spread of the virus by closing many businesses and limiting public gatherings. While Kentucky’s current total hovers around 500 cases, neighboring states that responded differently are experiencing much higher numbers. As of Tuesday, Indiana reported 2,159 cases, Ohio 1,933 cases, and Illinois more than 5,000 cases.
Especially troubling for Stack and other Kentucky officials is what’s happening in Tennessee. Although it has 1,834 cases statewide, there’s an alarming density of cases along Tennessee’s border with Kentucky, especially along and just west of the Interstate 65 corridor.
“If you go over the border into that area, you are going right through the most intense cluster of coronavirus in that two-state area,” says Stack. “If you do that, you run the risk bringing it back.”
That prompted Beshear last Friday to ask Kentuckians not to travel to Tennessee. On Monday he issued an executive order to restrict most out of state travel, and to require Kentuckians who have been out of state to self-quarantine for 14 days upon their return.
Stack says American officials could have used what was learned from how the virus spread in China and across Europe to develop better state by state responses in this country.
“I think we had an opportunity to be more consistent and more uniform,” says Stack. “It’s an unfortunate opportunity we missed.”
Preparing for the Worst
On Monday, Gov. Beshear said COVID-19 may not peak in Kentucky until May. Until then state officials are drafting plans to use hotels, the Kentucky State Fair and Exposition Center in Louisville, and other venues around the commonwealth as makeshift care facilities.
“It’s a big task,” says Stack, “essentially the mobilization of a massive sudden surge in hospital capacity.”
The commissioner says the state is also working to implement drive-through testing across the state, but that effort has been slowed by difficulties in securing testing kits and personal protective equipment (PPEs) for the medical staff conducting the screenings.
Beshear estimates that as many as 21,000 Kentuckians have already been tested. Stack says those who are healthy or who are mildly ill should not be tested. If an individual is very sick or at high risk because of advanced age or a preexisting health condition, they should consult with their doctor about getting a test.
Once a person is tested, though, Stack says they should assume they are positive and quarantine themselves until they get the results. But even that’s been difficult. At least two individuals in the state who tested positive initially refused to quarantine until law enforcement intervened.
“This is a democracy, this is not something where we can compel everybody to do things we tell them to,” says Stack. “For the people who are not following these guidelines, you’re being awfully cavalier not only with your own life but with a lot of other people’s lives.”
State or federal health officials could require further restrictions as the death toll mounts. Stack says the success of the existing measures and those that may be enacted in the future relies on people doing their parts to cease high-risk behaviors. He acknowledges that some rules are unpopular, such as limiting visitors to hospitals, nursing homes, and prisons, but he asks people to not confront health care workers and security guards about the policies.
“Nobody likes this,” he adds. “It’s what’s necessary in a really uncertain time.”
Protecting the Elderly
Kentucky has not yet had a significant incidence of COVID-19 among those living in the state’s nursing homes. A senior care facility near Seattle, Wash., made headlines in early March when a major coronavirus outbreak there resulted in the death of 35 residents. Last week, a nursing home just north of Nashville reported more than 100 residents and staff tested positive for the virus.
“We’re mandated under federal law to have infection control procedures,” says Betsy Johnson, president of the Kentucky Association of Health Care Facilities. “We went through a bad flu season, so we’ve been isolating individuals who had contracted the flu, so we’re prepared but this is a very, very different infection.”
Like hospitals, Johnson says senior care facilities also face a shortage of PPEs. She says she’s working with local health departments and the Inspector General in the state Division of Health Care to locate more masks, gloves, and gowns. She says it’s not just a matter of finding the PPEs, but also ensuring the quality of the supplies.
As the pandemic has spread and stress among health care workers has increased, Johnson says her facilities have encountered another challenge.
“We are having staff quit on the spot, which is troubling but there’s a lot of fear out there,” she says. “We are going to do everything we can possibly do to support our workforce and also make sure COVID-19 doesn’t come into any of our buildings.”
In addition to restricting visitors to nursing homes, Johnson says the facilities have taken other steps to protect residents. She says staff and anyone else entering the facilities will have their temperatures taken and be asked five screening questions. She says one of the lessons learned from the Washington state outbreak is that physical therapists, hospice nurses, and first responders were among those carrying the coronavirus into long-term care facilities.
To combat loneliness and isolation, Johnson encourages family members and friends to connect with nursing home residents by phone or video chat.
“Communication is more important than ever,” she says.
Finally, if you’re concerned about a resident, Johnson recommends calling the on-site facility administrator or contacting the long-term care ombudsman for your region. That information is available on the ombudsman’s website.
Investigating Price Gouging and Fraud
On March 7, Gov. Beshear issued an executive order to prohibit price gouging in the commonwealth. Attorney General Daniel Cameron says his office has received more than 1,700 complaints so far to the state’s consumer protection hotline at 1-888-432-9257, or to the website ag.ky.gov/pricegouging.
Cameron says gouging is charging a price for medical supplies, food, and other products that is grossly in excess of what those items cost before the crisis. He says he’s seen price hikes on goods ranging from 25 percent to 1,900 percent above normal cost.
“We’re coming after you if you are price gouging Kentuckians, especially in light of this pandemic,” says Cameron. “It’s so critical that everybody here in Kentucky step up and do their part in trying to help push back on this pandemic.”
Penalties for price gouging are $5,000 for the first violation, and up to $10,000 for the second violation. Cameron says the most notorious case so far involved two brothers from Tennessee who bought up masks, gloves, disinfectant and other products in stores along Interstate 75. They then took the supplies back to Tennessee with the intent to sell them at inflated prices. Working with Tennessee Attorney General Herbert Slatery, Cameron says authorities were able to get the brothers to donate their goods to area health care agencies.
“From my judgment, getting that personal protective equipment back out into our communities, back to our first responders... is a good result,” says Cameron.
The attorney general has also partnered with the Assistant U.S. Attorneys from the eastern and western districts of Kentucky along with the FBI on a Coronavirus Fraud Task Force, which will investigate and prosecute scams and other fraudulent activity related to the pandemic. He says anyone concerned about bogus charity appeals or other frauds should contact his office.
Cameron says his staff also stands ready to enforce orders issued by the governor’s office or the secretary of the Cabinet for Health and Family Services. But Cameron has drawn criticism from the American Civil Liberties Union of Kentucky for trying to use the crisis to halt abortions in the commonwealth.
Both Gov. Beshear and acting CHFS Secretary Eric Friedlander have called on health care providers to cease all elective and non-urgent medical procedures during the crisis. Cameron says Friedlander should clarify that that order includes abortions so that the attorney general’s office can respond accordingly.
“We have offered our help, consistent with that order, to Secretary Friedlander and the governor,” Cameron says. “We’re not trying to in any way do anything that’s inconsistent with that order and want to make sure that everybody here is complying.”
Cameron says he has not gotten a response from Friedlander on the matter.
Voting During a Pandemic
Another executive order issued by Beshear delayed the state’s primary election from May 19 to June 23. The governor made that move at the recommendation of Secretary of State Michael Adams.
“It wasn’t a decision I made lightly,” says Adams.
State law allows for a delay of up to five weeks. Adams says no further extension is possible without an action from the legislature to grant the governor and the secretary of state additional emergency powers. He says the current delay will give his staff, the state Board of Elections, and county clerks time to develop contingency plans for voting if the crisis extends into late June.
“We’re not going to cancel the election,” says Adams. “The other thing that’s off the table for certain is a vote-by-mail system involving us sending out ballots to every registered voter. That would be wildly irresponsible.”
Adams says 10 percent of the state’s voter rolls are inaccurate, so a blanket mailing of ballots to all registered voters would invite widespread fraud. Instead he envisions a combination no-excuse absentee balloting and limited in-person voting, probably with a curb-side option.
“I think that we can do at the [county] clerk level what restaurants are doing: provide a process where there’s social distancing but people are still able to cast a ballot,” he says.
To receive an absentee ballot, Adams says voters would have visit a website, input their Social Security number, and request a ballot.
Adams says he and the governor can use their emergency powers to ask the Board of Elections to establish new elections procedures, but he says the law is vague on just how much change would be allowed. Instead he wants the legislature to grant permission to allow the no-excuse absentee balloting for this special circumstance.
Adams says he has two such proposals before lawmakers, which he hopes they will act on before the end of the General Assembly session. He says it’s important for everyone to agree on the process, so as to avoid the confusion that occurred in Ohio in mid-March when Gov. Mike DeWine, public health officials, and state courts sparred over whether to proceed with their primary election vote.
“I want us to all be on the same page here, and have clarity and unity on this,” says Adams.
Another change could loom for voters in general election balloting on Nov. 3. The legislature recently approved a photo identification requirement for all voters, but Gov. Beshear has yet to sign the measure.
Adams says the final version of Senate Bill 2 stipulates that individuals without a proper ID can still vote if a poll worker attests to their identity, or if the voter signs an affidavit explaining why they were unable to obtain a photo ID. He says the bill includes a provision to provide free IDs to those who otherwise couldn’t afford one.
