Host Renee Shaw interviewed state officials and medical experts to get the latest information on the coronavirus pandemic in Kentucky, including plans for distributing vaccines and mitigating the spread of new variants of the virus. Guests also answered viewer questions.
Supply of Vaccines Is Limited, but Not For Long
Kentucky Public Health Commissioner Dr. Steven Stack, MD, says that as of early February, COVID-19 cases and hospitalizations are trending downward. Deaths from the virus are still high, but Dr. Stack says that deaths are a lagging indicator of the virus’s spread within a community and should also decline soon.
One reason for Kentucky’s improved COVID-19 numbers is that people have more fully adopted mitigation measures such as social distancing and mask wearing. But another cause is the rollout of vaccines in Kentucky. They are being distributed to citizens based on a system that prioritizes health care workers, persons in long-term care facilities, those with underlying medical conditions, and the elderly (detailed information can be accessed at https://govstatus.egov.com/ky-covid-vaccine).
“I think what we see right now is that the demand for vaccines so far outstrips the supply,” Dr. Stack says. He explains that each state in the U.S. gets a supply of the Pfizer and Moderna COVID-19 vaccines based on the state’s proportion of the national population. In Kentucky’s case, that comes to about 1.3 percent of the vaccine supply.
“The Biden Administration, when they came in, increased what we were getting by 16 percent their first week, and then another 5 percent the next week,” Dr. Stack says. “We’re probably settled in at a relatively stable rate now for a couple of weeks, and they’ve assured us that we’ll never get less the next week than the week before, which is very reassuring.”
Dr. Stack adds that the Biden Administration is supplying vaccines to its federal distribution program. Those will be provided at Walgreen’s pharmacies in Kentucky along with some independent pharmacies that service rural areas.
“The data that I have today [Feb. 8] is that we’ve used in the state-based programs about 91 to 92 percent of all the vaccine we’ve received,” Dr. Stack says. “Our goal was 90 percent in seven days, so we’re already there…. I know it started not as quickly as some would want, and of course we all want [the vaccine] yesterday, but we’re ramping up and we’re building a system that’s going to be able to take in all the new vaccines.”
Kentucky Transportation Secretary Jim Gray, who is overseeing the state’s vaccine distribution, says that Kentucky has vaccinated almost 10 percent of its population as of Feb. 8. “Judging from where we were seven weeks ago when the vaccine was released – and I’ve only been aboard three weeks myself – Kentucky is ahead of the pack,” he says. “That 10 percent is actually better than a number of our neighboring states.”
Gray says that Gov. Andy Beshear established four criteria when opening high-volume vaccination centers such at places such as Louisville’s Broadbent Arena and the Kentucky Horse Park near Lexington: 1) population density of the area; 2) health equity; 3) a system to efficiently vaccinate large numbers of people per day; and 4) patient transportation time to the site. “No one should have to drive more than one county away to get a vaccine,” he says.
These high-volume sites near Kentucky’s biggest cities are ramping up distribution, but Gray says that expansion into rural areas will occur soon, noting that there are almost 1,500 eligible vaccine providers under consideration. Some of the current vaccines allotted to the state are already being distributed to rural public health departments, and more providers out in Kentucky’s 120 counties will be enlisted as soon as the vaccine shipments increase.
“How long before we get there? My expectation is that if we get more vaccines – and the governor, Dr. Stack, and I have repeated these three words, ‘supply, supply, supply’ – it may not be too far away, a few months, that the supply will actually be greater than the demand,” he says.
What to Know About New Coronavirus Variants
In recent weeks, potentially harmful new variants of the SARS-COVID-2 virus have been found around the world. Two in particular have received a lot of attention: a variant from the United Kingdom and one from South Africa. Both have been found to be more contagious than the common variants in the U.S., and the South African one appears to cause more severe symptoms. Dr. Stack says that as of the first week of February, the U.K. variant has already been identified in Kentucky.
“We announced two cases that we found, there’s a few more, which we would expect,” Dr. Stack says. “We have not yet found the South African variation – but it’s just a matter of time. It’s inevitable, and that’s why people have to do social distancing and masking, because if we let it spread too much before we vaccinate enough people, then you run the risk of having a predominant strain that’s actually more effective.”
Dr. Jon Klein, MD, Vice Dean for Research at the University of Louisville School of Medicine, says that research from the University of Washington published in February indicates that persons who had contracted COVID, recovered and then received their first vaccine dose developed antibodies to the new, more virulent strain first found in South Africa. “That is a real surprise, and if it’s confirmed it will be very encouraging,” Dr. Klein says. “At the very least, if it’s confirmed it will tell us that we can maybe stretch the supply of vaccines in that group of people (who’ve already had COVID) and create more opportunity for people who have not yet had the disease.”
Reducing Vaccine Hesitancy
Around 55 percent of the more than 4,000 deaths from COVID-19 in Kentucky through early February have occurred in long-term care facilities. However, during the early vaccine rollout in the commonwealth, less than half of staff members at long-term care facilities have been immunized, compared with around 75 percent of residents. Dr. Stack says that rectifying this imbalance is a high priority.
Dr. Stack explains that his goal as public health commissioner is to reach Kentuckians in “their place of comfort” and have a direct and empathetic discussion with them that acknowledges their concerns but emphasizes that the risks of getting vaccinated are far outweighed by the benefits. “In fact, other than feeling poorly for a day or so after your second dose, most vaccines haven’t really demonstrated any serious risks,” he says.
Vincent Venditto, PhD., from the University of Kentucky College of Pharmacy says that healthcare professionals must be committed to educating the public about COVID-19 vaccines to clear up misinformation. In particular, he advises people to take whatever vaccine they’re offered and not get caught up in comparing reported efficacy rates. The Pfizer and Moderna vaccines have over 90 percent efficacy protecting against symptoms from COVID, while a vaccine soon to be released by Johnson & Johnson has been found to have an efficacy rate of around 65 percent.
“If it’s approved at the time, I think it’s reasonable to get the Johnson & Johnson one, as well,” Venditto says. “The health agencies are doing what they can to make sure that everything that’s out and getting into people’s arms is safe and effective and is going to provide the protection that we need.”
Dr. Klein agrees with Venditto’s advice and says that while it is still unknown how well receiving a COVID-19 vaccine prevents one from spreading the disease, research conducted in Israel shows promising results after the country vaccinated approximately 30 percent of its population. “They are observing a decrease in transmission, and they don’t know yet if it’s because they’ve gone under another very strict lockdown or whether it’s from the vaccines,” he says, “but my money would be that it’s because of the vaccines.”
Roy Milwee, the CEO of Ambulatory Services at Appalachian Regional Healthcare, says that, overall, the folks he serves in his eastern Kentucky region have been receptive to getting vaccinated, with winter weather the main obstacle to keeping appointments. Milwee says that his unit has not wasted a single vaccine and has an ample backlog of patients to contact if a person does not show up.
Milwee advises those wanting a vaccination to visit the website at https://arhcovid19.com/arh-covid-19-vaccine-registration/ to sign up. “We’ll put them on a wait list, and each community will contact them once vaccines are available,” he says. “Clearly, we’re following the priority list set forth by the state and the CDC, focusing on essential workers, healthcare, and those 70 and over at this time.” For those in the area who do not have access, Milwee advises them to call the hotline 855-ARH-CARE (855-274-2273).
A recent CDC report found that persons of color have died at nearly three times the rate of white people diagnosed with COVID-19. There is also a higher reluctance among these groups toward getting vaccinated, based in part on a historical mistrust of the healthcare system that developed over decades due to racist practices such as the Tuskegee experiment during the 20th century, where Black males were intentionally infected with syphilis and not treated. Dr. Wayne Tuckson, MD, a colorectal surgeon and the host of KET’s Kentucky Health, says that one out of five Black persons are essential workers, meaning that many of them have been forced to work among the public during the pandemic.
“We already have a community that has increased exposure, just by nature of what they’re doing,” he says. “These are the same groups of people that tend to have the poorest reports when it comes to overall health. Finally, these are the individuals who tend to be at the lower end of the socioeconomic scale. They have less access to health care, and they tend to live in neighborhoods that tend to be less healthy – for example, areas that tend to have higher pollutants.”
What can be done to improve vaccination rates among Blacks and other persons of color? Dr. Tuckson says that it will require medical professionals and influential figures from within a particular community to speak out and motivate their neighbors to get vaccinated, and even lead by example. He participated in the AstraZeneca COVID-19 vaccine trial and is committed to share his experiences with his neighbors in Louisville and other Black communities around the state. “It’s a difficult sell, but it’s not an impossible sell,” he says. “We have to get the message out, and I think the messengers have to be trustworthy, and hopefully by people seeing me do it, they’ll say, “Hey, it’s safe to do.”
Envisioning a Post-Pandemic Future
“I am very optimistic, but cautiously optimistic, that as we enter the summer, we are going to start to feel like things are improving,” Dr. Stack says. “We’re going to have warmer weather, people are going to be outdoors, and the infection rates will hopefully stay low. We’re going to have more people vaccinated, particularly the vulnerable so the hospitals are less likely to be strained. I think that’s going to continue to improve over the summer as we vaccinate more, and I think this summer will feel more like the summers we used to know.”
However, Dr. Stack cautions that social distancing and mask wearing will still be common during the summer, and when school begins in the fall, as well. He notes that mask wearing is socially common in the Far East, which has experienced respiratory virus outbreaks several times so far this century. Dr. Stack foresees that persons who feel themselves vulnerable to viruses such as SARS-COVID-2 will wear masks more often, even as others may stop wearing them after the pandemic subsides. “I think that masks are going to become more a part of the Western culture than they ever were before this pandemic,” he says.
Dr. David Dougherty, MD, an infectious disease specialist with Baptist Health Lexington, feels that COVID-19 could become a constant, but controlled, presence in our lives. “As vaccines roll out even more, we may be more protected for the long term, and we may have to develop new boosters as these new variants come out, but likely this will be with us for years,” he says.
Answering Viewer Questions
I was told not to take pain medications before or after getting the vaccine. How long should I wait?
“Pain medicine can certainly affect your immune response,” Venditto says. “I know the symptoms associated with the second dose can be uncomfortable, so I know that while you don’t want to take an excessive amount, I think it’s reasonable to take ibuprofen after the second dose if you are having some really significant symptoms.”
“With regards to the ibuprofen, I think it’s important to not take that prophylactically before the second shot,” Dr. Doherty says. He also recommends taking acetaminophen [Tylenol] instead of ibuprofen after receiving the vaccine since it’s not an anti-inflammatory medication.
Are there persons who are immuno-compromised that should not be getting a vaccine? What about expectant mothers?
Dr. Dougherty says that someone taking a corticosteroid drug such as Predisone to treat inflammation should make sure they have completed their prescription before getting vaccinated. “For those that are on chemotherapy, and are going to be on it for a long time, we really don’t know the level of response in those folks because they weren’t included in the clinical vaccine trials,” he says. “That being said, if you’re going to be on immuno-suppressive therapy for the indefinite future, I would still recommend getting the vaccine.”
He also recommends that expectant mothers get vaccinated, even though he concedes that pregnant women weren’t included in clinical trials either. “It’s all a risk-benefit situation,” he says. “We’ve had quite a few pregnant women become very sick in the hospital [with COVID-19], and so I think the benefit outweighs the risk in that situation.”
Why does a person who receives monoclonal antibodies to treat COVID-19 have to wait 90 days to get vaccinated?
“You have the monoclonal antibody in your system for about three months,” Dr. Doherty says, “and your body’s long-term immune response will not be as good, at least that’s the thought, if you get the vaccine before that three-month period is up.”
“There was some evidence in a couple of research studies that the antibody treatment actually suppressed the response to the vaccine,” Dr. Klein adds. “So that’s another reason for the wait.”
