As new COVID-19 case numbers continue to decline and vaccination rates slowly increase, Gov. Andy Beshear is expected to lift this week nearly all the remaining restrictions put in place over the past 15 months to protect Kentuckians from the novel coronavirus.
But while many Americans cheer a return to normal life without masks and social distancing, health experts caution that the pandemic is still with us.
“All of us would like to think that indeed it’s over, but I’m afraid that it’s not yet,” says Dr. Paul McKinney, associate dean of the University of Louisville School of Public Health and Information Sciences. “It won’t be over until, really, all of the outbreaks are controlled around the world.”
Since COVID will continue to circulate and evolve, McKinney says it could mutate into strains that are resistant to the currently available vaccines. If that happens, he says we could experience additional surges in cases.
Dr. Ashley Montgomery-Yates, chief medical officer for inpatient, emergency, and core services at UK HealthCare, says viruses like COVID have been mutating for millions of years.
“The coronavirus mutated from the common cold into this virus that then could cause lung injury, which is the majority of what people were dying from,” says Montgomery-Yates. “It will mutate again. It may mutate and become less virulent. It may mutate and become more.”
The two doctors urge everyone who is eligible to get vaccinated, which they say is crucial to stopping the spread of COVID and would limit the virus’ ability to mutate. Also, they say if more people get vaccinated, that protects immuno-compromised individuals (such as organ transplant or cancer patients, or those suffering from rheumatoid arthritis or Crohn’s disease) for whom the vaccines may be less effective at fighting off COVID. The U.S. Centers for Disease Control and Prevention says just over 42 percent of Americans are fully vaccinated.
“We don’t know exactly when herd immunity will be reached – it’s not been defined for this particular coronavirus,” says McKinney, who serves on the CDC’s Advisory Committee on Immunization Practices. “We anticipate that it’s… probably in the 70-plus percent range.”
The Challenges of Vaccinating More Kentuckians
More than 2 million Kentuckians, or about 47 percent of the population, have received at least one dose of a COVID vaccine so far. Only 39 percent of residents have been fully vaccinated.
Older individuals lead the state in terms of vaccinations, with more than 1.1 million Kentuckians ages 50 and older having received at least one shot, according to the state’s COVID Vaccination Dashboard. In contrast, fewer than 300,000 Kentuckians from age 12 to 30 have received their first dose. (Adults have been receiving vaccinations since December, but it wasn’t until May that the Pfizer vaccine was approved for use in children between the ages of 12 and 17.)
While the vaccines aren’t 100 percent effective at preventing someone from contracting COVID, research indicates they do reduce the possibility of getting the virus, and they can also reduce the severity of the symptoms among those who do.
“We have this marvelous, beautiful vaccine that was created that is going to change everyone’s lives back to normal, and what we need is for them to go get it,” says Montgomery-Yates.
The protective nature of the vaccines is bearing out in the cases doctors are seeing. Montgomery-Yates says UK HealthCare currently is seeing a small spike in cases occurring mostly among those who have not been vaccinated and among younger people.
Dr. Ayorinde Medaiyese, a pulmonologist at Pikeville Medical Center, says he has seen a dramatic reduction in COVID admissions in recent weeks, and a decline in the number of patients requiring ICU care. He says death rates have also dropped. He credits those improvements to people getting vaccinated.
“We could not control the virus with the social distancing and the masks,” Medaiyese says. “Obviously, they were very helpful in decreasing the prevalence of the virus, but the game-changer was the vaccine.”
Like his colleagues at UK, Medaiyese says he is seeing an increase in cases among young people. He says there is some data that indicates the current variants may be more aggressive in younger patients. For that reason, Medaiyese says he thinks vaccinations should be mandatory for youth.
“My recommendation would be that as long as the data supports the safety and efficacy in young people that this should really be a requirement,” he says. “I think that’s the only way we’ll be able to contain this virus.”
But McKinney says there’s no legal precedent for mandating a drug that is available under Emergency Use Authorization (EUA) from the federal Food and Drug Administration. He says getting a EUA for a vaccine only requires evidence that the medical benefits are greater than the risks. To receive full approval, McKinney says vaccine-makers would have meet much higher standards for safety and efficacy. He says government officials could consider a mandatory vaccination requirement for a vaccine that has received full FDA licensure.
But vaccine mandates, whether for youth or adults, would likely be highly contentious. The Kentucky General Assembly passed legislation earlier this year that provides exemptions for people facing a vaccination requirement during a pandemic. Senate Bill 8 became law without Gov. Andy Beshear’s signature.
Senate Health and Welfare Committee Chair Ralph Alvarado, who is a practicing physician, says people shouldn’t fear the COVID vaccines despite the speed with which they were approved for use. The Winchester Republican says such vaccines, which use messenger RNA (or mRNA) technology, have been researched for decades. Instead of carrying a weakened form of the virus, the COVID vaccines teach human cells how to make a special protein that triggers an immune response, which can fight off a COVID infection.
“People often will watch a lot of videos on Facebook or social media and different things and think this is somehow going to inject [micro]chips or it’s going to rearrange my DNA,” says Alvarado. “It’s not.”
Another common misconception, says Montgomery-Yates, is that individuals who had COVID don’t need to get vaccinated because they’ve already developed immunity to the virus. She says a COVID-survivor’s level of immunity can vary greatly depending how much virus they had and how much antibody response their body generated.
“Even if you were positive, you still should get the vaccine because we know that you’ll get a good enough antibody response to be immune down the road,” says Montgomery-Yates.
Given the success of the mRNA vaccines, McKinney says drugmaker Moderna is already working on a combination vaccine for COVID and the flu that people could take each year to combat both viruses.
“Based on what we’ve seen so far, the RNA technology is tremendous,” says McKinney. “I don’t think anyone could have predicted that it would work this well.”
An Uncertain Future for COVID ‘Long-Haulers’
Even as the pandemic wanes, much uncertainty still remains about the lingering health impacts among people who had serious cases of COVID. These so-called “long-haulers” report ongoing issues with lack of taste and smell, impaired brain function, anxiety, and depression.
“The impact of COVID goes well beyond hospitalization into the recovery periods, and we’re just beginning to understand what that means,” says McKinney.
Montgomery-Yates says many of those symptoms are common among patients who have long ICU stays for a variety of conditions. While her hospital saw one or two patients a month pre-COVID for such issues, she says during the pandemic, they were swamped with people complaining of those symptoms. But she adds that it’s not just those COVID patients who had long ICU stays that are experiencing long-term effects.
“There’s this other group that really weren’t that sick – they didn’t go to the ICU, maybe they were in the hospital for a few days – but months later they say, ‘I am not the same.’… It will be interesting to see… how we as a society take care of them.”
Navigating Pandemic Politics
The impending end to COVID restrictions is a welcome relief for many Kentuckians, and considered long overdue by many others. Sen. Reggie Thomas (D-Lexington), who is Senate Minority Caucus Chair, credits Gov. Beshear for following scientific data and federal guidance in deciding to close schools and high-traffic, non-essential businesses during the early months of the pandemic, despite facing sometimes withering public and political criticism.
“His listening to the science worked... Kentucky had the third fewest deaths of any southern state,” says Thomas. “He saved thousands and thousands of lives of Kentuckians. Now they may have not liked it, but you can’t question the results.”
Thomas also praises Beshear for his leadership and persistence on vaccinations, which he says made Kentucky third among all southern states in terms of people vaccinated.
“That’s a tremendous job given the vaccine hesitancy that we see in this part of the country,” says Thomas.
Sen. Alvarado agrees that Beshear’s early response was good given all the unknowns during the first weeks of the pandemic. But he says Kentuckians soon grew weary of the restrictions that to some seemed arbitrary.
“Once we got into about May or June and we started realizing what we’re dealing with, people were saying, ‘Hey, how come all these rules are being put in?’’”
Alvarado says the decision whether to keep schools open to in-person instruction should have been made locally, especially after pediatricians and other public health officials said children should be back in school.
In response to Beshear’s pandemic actions, the Republican-controlled General Assembly passed several bills to limit a governor’s use of executive orders and give legislators more input in ongoing states of emergency. Another bill would allow businesses to follow either state or federal pandemic guidance, whichever is less restrictive.
The Kentucky Supreme Court is slated to hear challenges to those new laws this week. Thomas says he hopes the court decides the legislature overreached in passing those bills.
From the health care perspective, Dr. Montgomery-Yates says she thinks fear drove many of the early decisions state officials made early in the pandemic.
“I truly don’t think that anyone really had the knowledge that we were going to have a worldwide pandemic of this magnitude,” says Montgomery-Yates. “When it happened, I think we were all without a playbook.”
Alvarado says the Health and Welfare Committees of the Kentucky Senate and House of Representatives will review the state’s response to the pandemic and any related fallout, such as how high rates of smoking and obesity among Kentuckians impacted health outcomes for COVID patients. He also wants to explore the use of telemedicine services, and changes to rates of child abuse and domestic violence during the lock-down period.
