It’s a virus that can spread exponentially.
That’s how Kentucky Public Health Commissioner Dr. Steven Stack describes the coronavirus responsible for the COVID-19 pandemic. If one person who has the virus spreads it to three people, and then each of them gives it to three people, then that original patient will have infected more than 1,000 others in just two weeks.
The state identified its first COVID-19 patient on March 6. As of March 23, there were some 124 positive cases of coronavirus in the commonwealth. But as of last weekend, only about 2,000 people out of a state population of 4.4 million had been tested.
“We have to be very careful taking false assurance in the small numbers now because they can very quickly increase,” says Stack.
About 30 counties have positive cases, but on Monday, Gov. Andy Beshear warned that coronavirus was likely present in each of the state’s 120 counties. Stack takes that warning even further.
“Every Kentuckian should assume that this is probably in your neighborhood, which is why these admittedly unusual precautions we’re taking are so important,” says the commissioner.
Stack says 80 percent of patients will be fine, but for the other 20 percent, who are often older or already medically frail, the virus can be devastating.
Why Closures and Distancing Are Important
The commissioner says case numbers will continue to increase despite the measures enacted by the governor and public health officials to close businesses and public spaces, enforce social distancing, and encourage hand washing. One reason is that the coronavirus is a tenacious fighter even outside a human host. Stack says the virus can live on a range of surfaces – from clothing, to doorknobs, to countertops – from a few hours to as many as nine days.
“Even if we stopped all the transmission of infection, you can expect to see a week or two of continued increase because those are infections we didn’t prevent until we put the measures in place,” says Stack.
While the preventive measures have brought the economy to a standstill, Stack says the protections are critical. They limit the spread of the virus, especially among vulnerable populations. He says they also buy federal, state, and local governments time to increase testing capacity and muster health care resources needed to treat those battling the virus.
“We wouldn’t do these things if we didn’t think the stakes were really significant, and that if we didn’t believe in our heart of hearts that this is going to save a lot of people’s health and even perhaps a lot of lives,” says the commissioner.
The governor is working to make drive-through testing available across the commonwealth, but Stack says that won’t be open to just anyone. Quantities of testing kits are still limited, and supplies of personal protective equipment (PPE) for medical personnel are scarce. The commissioner says testing should target individuals over 60 years of age and those with preexisting health conditions.
For individuals who are well, Stack says being tested is not helpful because a negative result doesn’t necessarily mean they don’t have the virus or that they won’t contract it later.
“If you have the disease, mostly likely the test is going to find it,” he says. “If you don’t have symptoms, you may just be too early in the disease and not have enough of that genetic material in your system for us to find it.”
The commissioner says people with a cold or the flu who wouldn’t otherwise bother seeing a doctor should self-isolate at home. If a person is very ill and develops difficulty breathing, then they should seek medical care.
For now, Stack says there is no treatment to cure patients, and a vaccine to prevent COVID-19 is at least a year away. He also says there is no research to confirm the efficacy of using anti-malaria drugs promoted by President Donald Trump to treat COVID-19. Stack says people should not attempt to self-treat with chloroquine and hydroxychloroquine because he says those drugs have known side effects. Plus, the people who need the medicines to treat other conditions such as rheumatoid arthritis and lupus may be unable to get the drugs.
Health officials also don’t yet know if warmer weather will help limit the spread of the virus as is often the case with seasonal flu. Stack says they also don’t know if people who recover from the coronavirus are immune from re-infection. Finally, he cautions that the protective measures will likely need to continue for some weeks to prevent massive spikes in caseloads.
“We’re going to get through it because we come together as a community and because we look out for each other and love our neighbors,” says Stack.
The State Budget
While public health officials battle the coronavirus, state lawmakers are trying to finalize a new state budget amid unprecedented economic uncertainty and social distancing recommendations.
The General Assembly adjourned last Thursday after rushing through several bills, including House and Senate versions of a biennial spending plan. On Monday, a bipartisan, bicameral conference committee of lawmakers met to begin to reconcile the differences between the two documents.
“The budgets are pretty close in a lot of ways,” says House Minority Floor Leader Joni Jenkins (D-Louisville). “The biggest challenge for us is forecasting how much money we’re going to have because we’ve never seen anything like this COVID-19 crisis.”
The House crafted their budget before the COVID-19 crisis hit, using budget forecasts created for lawmakers by the Consensus Forecasting Group back in December.
“They budget to a pessimistic option, they budget to a middle-of-the-road option, and they budget to a really optimistic option,” says Senate Majority Caucus Chair Julie Raque Adams (R-Louisville). “So, we’re trying to figure out, do we go with the pessimistic option, do we go with the middle-of-the-road option and put in some [fiscal] guardrails? We certainly know we can’t go with the optimistic option.”
Adams and Jenkins agree that during this crisis, public health and Medicaid spending should be the top spending priorities. Adams says lawmakers must also consider federal stimulus funds the state may receive in the coming weeks, and how to give Gov. Beshear the flexibility to allocate that money when lawmakers are no longer in session.
“We have to give people in the state of Kentucky some continuity and some assurances that they’re going to be protected in their lives and in their livelihoods,” says Adams. “We [also] need to be cognizant of the taxpayers... because the taxpayer is going to be so stressed right now more than any time we’ve ever seen in the last 10 years.”
But time is not on the side of lawmakers. The state constitution mandates they adjourn the session by April 15. To maintain their veto override options, the legislature must get a completed budget to the governor on or before April 1. If they can’t reach a budget agreement in time, lawmakers could enact a continuation budget, or delay the budget work for now and let the governor call them back into special session in May or June.
“The courts have ruled that if we don’t have a budget by the end of the fiscal year, government would have to shut down. We cannot allow that to happen,” says Jenkins. “We don’t know that June is going to be any better… We need to get through this as soon as possible so we’re not in that situation.”
Even if they do enact a budget, lawmakers could still be called back to Frankfort. The constitution says that if state revenues decrease more than 5 percent of what the budget projects, the governor must reconvene lawmakers to adjust the spending plan. Jenkins says she and her colleagues realize that’s a distinct possibility given the economic crisis facing the state and nation from the coronavirus and how it will impact tax receipts for the commonwealth.
Public Pensions and Other Legislative Issues
The recent stock market losses and possibility of a recession will mean further pain for the state’s beleaguered retirement systems. Jenkins and Adams say lawmakers should remember that the immediate crisis will pass, the markets will recover, and pension plan earnings will get back on track.
One pension issue lawmakers will need to resolve is how to best help quasi-governmental agencies that are buckling under their escalating pension obligations. Jenkins says at issue is whether regional universities, health departments, rape crisis centers, and other agencies will pay their pension obligations based on a percentage of their payroll or based on their share of the pension debt, amortized over 30 years.
The pandemic may also sideline priority bills for the two chambers. Senate Bill 1, an immigration enforcement measure, passed the upper chamber, but has yet to be heard by the House Judiciary Committee. Adams says it’s tricky to proceed with such potentially contentious legislation when the public can’t participate in committee hearings. The governor has closed the capitol to visitors during the health crisis.
“We can’t have that citizen input,” says Adams. “That’s a problem with our democratic process, and so I don’t know if we can find a solution to that or not.”
Meanwhile, House Bill 1 on public assistance reform passed the lower chamber but awaits a hearing in the Senate Health and Welfare Committee. Jenkins says she hopes senators will add committee substitutes that could prevent people from losing crucial benefits like food stamps and Temporary Assistance for Needy Families.
“Right now does not seem to be the time to be drawing hard lines in the sand for public assistance,” says Jenkins. “So many of our people who work for small business [and] small business owners, those folks are going to be so hard hit in the next couple months.”
The General Assembly is scheduled to convene on Thursday and then again on Wednesday, April 1 before adjourning for the veto period. Their final working days are scheduled for April 14 and 15.
The View from the Business Community
As of Monday night, Gov. Beshear ordered all non-essential retail businesses to close. Groceries, pharmacies, liquor stores, gas stations, farm and pet supplies, and car repair services can remain open, as can restaurants that only offer takeout and delivery.
Those forced closures along with temporary shutdowns at many factories have left as many as 60,000 Kentuckians suddenly unemployed.
“That just shows what it has done to businesses across the state that are having to shut their doors,” says Kentucky Chamber of Commerce President and CEO Ashli Watts. “It’s a scary and uncertain time but Kentucky businesses, as we know, are resilient.”
Watts says she hopes the federal stimulus package that Congress is negotiating will provide forgivable loans and other liquidity measures to help small and large businesses survive until the crisis abates. That legislation is expected to also give Americans who make less than $75,000 a year a check for $1,200, plus an additional payment of $500 per child. Watts says she hopes that legislation will pass this week so those payments can start going out next week.
“We will need some kind of stimulus from the government – unfortunately that’s just how it’s going to have to be” says Watts. “We need to money to put in people’s hands to have them go and spend, to have those small businesses come back to life.”
The state can also help with economic relief, according to Watts. Last week the House attached a committee substitute to a surprise medical billing measure that offers relief to businesses and workers impacted by the pandemic. Watts says it includes tax relief for small businesses, liability protections for companies that shift to manufacturing PPEs and hand sanitizers, and extensions to various business filing deadlines. She says she hopes the Senate will further amend Senate Bill 150 with additional relief for the business community.
“There’s lot of different tax issues, especially for small businesses... that really could help them,” she says. “These things should not [go] on in perpetuity, but for a short period of time. Sometimes that does help Kentuckians recover a little faster.”
Before the crisis started, Watts says workforce officials were focused on how to fill the thousands of open jobs that existed in the commonwealth. Now she says they’ve had to shift their attentions to helping the newly unemployed find work. Even with all the closures, Watts says many companies are hiring people, including groceries, drug stores, freight haulers, and e-commerce sites.
Watts says the economy had been strong and employment at record levels before the pandemic hit. She says that should help the nation recover faster than it might have. She also says the forced work-at-home situations may lead some employers to explore new ways of doing business in the future. For now, she suggests that Kentuckians focus on staying home and social distancing to help limit the impact of COVID-19.
“We’re all very hopeful that in a couple months that things can get back on track, but this is a huge setback to our economy, to our jobs, to our businesses, to us as Kentuckians, and it’s not going to be fixed overnight,” says Watts. “But I think if we do what the experts tell us to do, we will come out of this on the other side much quicker and therefore can recover much quicker.”
