Kentucky Schools Struggle as Virus Outbreaks Close Entire Districts

By |2021-09-04T13:27:41-04:00September 4th, 2021|Uncategorized|

Daily Covid BriefingSept. 4, 2021Updated Sept. 4, 2021, 1:19 p.m. ETSept. 4, 2021, 1:19 p.m. ETMasked and distanced children heading to lunch at Wilder Elementary School in Louisville, Ky., as fall classes began in the state’s public schools on Aug. 11. As of Friday, 34 of the state’s 171 school districts had at some point closed because of coronavirus outbreaks and quarantines.  Amira Karaoud/ReutersAbout a fifth of Kentucky’s school districts have had to temporarily close since classes began last month because of coronavirus infections, an indication of the dire impact the most recent wave of the virus has had on the state.Kentucky has recently reached its highest levels of cases and hospitalizations since the start of the pandemic, largely because of the highly infectious Delta variant. Hospitals are becoming overwhelmed, and Governor Andy Beshear said on Thursday he was deploying the National Guard to help medical professionals. The rise in cases has also affected Kentucky’s schoolchildren, hundreds of thousands of whom are under 12 and so not eligible for vaccination. “More kids are getting Covid right now than we ever thought imaginable,” Mr. Beshear said at a news conference on Monday.As of Friday, 34 of the state’s 171 school districts had closed at some point during the new school year because of infections and quarantines, said Josh Shoulta, a spokesman for the Kentucky School Boards Association.The Centers for Disease Control and Prevention has emphasized returning to in-person classes, ideally with as many people as possible vaccinated and measures like universal masking in place. But those measures have become politically fraught. On Friday, anti-mask protesters demonstrating against Washington State’s mask mandate in schools forced several to close in the southern city of Vancouver (named for the same 18th century British sea captain as the younger but much larger city in Canada).Many states are in the midst of their worst wave of the pandemic since last winter, and children are very much a part of it. According to data collected by the American Academy of Pediatrics the number of cases in children increased exponentially, up from about 38,000 cases the week ending July 22 to nearly 204,000 for the last full week in August. Pediatric Covid hospitalizations are soaring.In August, Governor Beshear, a Democrat, rescinded an executive order mandating masks in schools after the state Supreme Court upheld laws passed by the Republican-led state Legislature limiting his power. However, Kentucky’s Department of Education has a mask requirement in place for public schools, in line with federal recommendations intended to make the resumption of in-person schooling as safe as possible. Toni Konz Tatman, an Education Department spokesman, said that the mask rule appeared to make a difference based on the experience of some districts. “We had a couple districts that opened before the regulation was passed and their number of quarantines was significantly higher,” she said.Reopening schools has also been complicated by a shortage of personnel, especially substitute teachers and bus drivers, that was greatly worsened by rampant coronavirus infections and quarantines, Ms. Tatman said.“Our districts are pulling in all the people they can, they really are exhausting every possibility they can, but when it gets to the point where they can’t pull it off they are closing,” she said.For now, the hope of normalcy that many educators and parents had entertained has not come to pass, she said.“I think a lot of people were hopeful that we could start the year differently,” Ms. Tatman said. “It’s just not the case.”Two-month-old Carvase Perrilloux Jr. in the Pediatric Intensive Care Unit at Children’s Hospital in New Orleans last month.Erin Schaff/The New York TimesPediatric hospitalizations for Covid-19 have soared over the summer as the highly contagious Delta variant spread across the country, according to two new studies from the Centers for Disease Control and Prevention.From late June to mid-August, hospitalization rates in the United States for children and teenagers increased nearly fivefold, although they remain slightly below January’s peak, one new study found.But vaccination has made a difference. During this summer’s wave, the hospitalization rate was 10 times as high in unvaccinated adolescents as in those who were vaccinated, researchers found. Pediatric hospital admissions were nearly four times as high in states with the lowest vaccination rates as in those with the highest rates, according to a second study.The studies, released on Friday, do not provide clear answers about whether Delta causes more severe disease in children than earlier versions of the virus. The rise in pediatric hospitalizations could also be because of the variant’s high infectiousness.Indeed, one study concluded that the proportion of hospitalized children with severe disease had not changed in late June and July, when the Delta variant became dominant in the United States.The rates reported in the C.D.C. studies are based on data from two national surveillance systems, including hospitals in 49 states and Washington, D.C.In one C.D.C. study, researchers found that since July, when the Delta variant became predominant, the rate of new coronavirus cases increased for children 17 or younger, as did Covid-related emergency room visits and hospital admissions.“We saw that E.R. visits, cases and hospital admissions are rising,” said Dr. David Siegel, lieutenant commander in the U.S. Public Health Service and the lead author of the paper. “It could be that Delta is more severe or that Delta is more transmissible, and it could be related to other factors such as masking.”The study also found that Covid-related emergency room visits and hospital admissions among children were more than three times as high in states with the lowest vaccination coverage compared with states with high vaccination rates, underscoring the importance of communitywide vaccination to protect children. Other important factors that might affect regional differences included masking and social distancing measures, the study noted.Last month, as Delta surged, the incidence of Covid in children rose from earlier in the summer — reaching 16.2 cases per 100,000 children ages 4 or under; 28.5 cases per 100,000 children ages 5 to 11; and 32.7 cases per 100,000 children ages 12 through 17.That rate represented a sharp spike from a June low of 1.7 per 100,000 children ages 4 or under; 1.9 cases per 100,000 children ages 5 to 11; and 2.9 per 100,000 children between ages 12 and 17. It was still below the peak incidence of cases among children last January.The proportion of Covid patients under 17 who were admitted to intensive care units ranged from 10 to 25 percent from August 2020 through last June, and hovered at 20 percent by July 2021, according to the C.D.C. study.In a second study, researchers analyzed data from the Covid-Net surveillance network, which includes information on hospitalizations in 99 counties across 14 states.Over the course of the pandemic — or from March 1, 2020, to Aug. 14, 2021 — there were 49.7 Covid-related hospitalizations per 100,000 children and adolescents, the researchers found.But the weekly rates have been climbing since July. During the week ending Aug. 14, there were 1.4 Covid-related hospitalizations for every 100,000 children, compared with 0.3 in late June and early July. (That remains slightly below the peak weekly rate of 1.5 hospitalizations per 100,000 children, in early January 2021, in the post-holiday wave of cases.)Hospitalization rates have increased most sharply for children who are 4 or younger. In the week ending Aug. 14, there were 1.9 hospitalizations per 100,000 children in that age group, nearly 10 times as many as in late June.But based on the limited data available so far, it does not appear that the Delta variant is affecting the incidence of severe disease or deaths among children, which have been somewhat steady and relatively low throughout the pandemic.Among the children and adolescents hospitalized from June 20 to July 31, 23.2 percent were admitted to the I.C.U., 9.8 percent required mechanical ventilation and 1.8 percent died. Those figures were roughly the same as those for children who were hospitalized before the Delta variant became widespread.Travelers at Union Station on Friday in Washington, D.C., as Labor Day weekend began. Alex Wong/Getty ImagesThough the three-day Labor Day weekend typically signifies the unofficial end of summer and the last chance for many people to travel, health officials are trying to rein in that ritual this year as the highly contagious Delta variant fuels a rise in hospitalizations.Unvaccinated people should avoid traveling over the holiday weekend, said Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention. She identified vaccination and masking as key factors in preventing the spread of the virus.“Throughout the pandemic, we have seen that the vast majority of transmission takes place among unvaccinated people in closed, indoor settings,” Dr. Walensky said.However, the Transportation Security Administration reported that the number of travelers passing through its airport checkpoints on Thursday and Friday nearly equaled prepandemic levels. On Thursday, the agency logged 1,896,846 checks, about 90 percent of the 2019 number, and on Friday it reported 2,129,999 checks, about 97 percent of the 2019 level.Here’s what else happened this week:The United States was removed from the European Union’s “safe list” of countries whose residents can travel to the 27-nation bloc without additional restrictions, such as quarantine and testing requirements. Italy is requiring unvaccinated travelers from the United States to quarantine for five days, while the changes that other parts of Europe may put into effect are still undetermined.New Zealand on Saturday reported 20 new virus cases and one death — a woman in her 90s with underlying health conditions, according to health officials — pushing the country’s total death toll to 27. It is the only reported death since the country’s outbreak of the more transmissible Delta variant began last month and the first since February. New Zealand recently locked down to try to contain Delta’s spread.The World Health Organization is monitoring a new coronavirus variant called “Mu” — known by scientists as B. 1.621 — and has added it to the list of “variants of interest” because of preliminary evidence it can evade antibodies. Dr. Anthony S. Fauci, the top U.S. infectious disease expert, said that the United States has identified few cases involving Mu but that officials were monitoring the variant, which was first identified in Colombia in January and now makes up nearly 40 percent of that country’s cases.Federal regulators warned on Thursday that they might not have enough data to recommend boosters for anyone except certain recipients of the Pfizer-BioNTech vaccine by late September. Asked about the warning, a White House spokesman said, “We always said we would follow the science, and this is all part of a process that is now underway.”There were a number of notable people who were dealing with the virus this week, including: the hall of fame boxer Oscar De La Hoya; Joe Rogan, the host of a hugely popular podcast who previously said on his show that young healthy people need not get Covid vaccinations; and Ross Wilson, the chargé d’affaires of the U.S. Embassy in Kabul who helped manage the evacuation from the Kabul airport and who was the last diplomat to leave Afghanistan this week.People sat in the observation area at a mass vaccination clinic in Toronto earlier this year. Those aged 18 to 39 are a lagging demographic in the country’s vaccination rate.Cole Burston/The Canadian Press, via Associated PressAs another wave of coronavirus cases and hospitalizations rises in parts of Canada, its public health agency is urging young people, a lagging demographic in the country’s vaccination campaign, to roll up their sleeves.In a new analysis released on Friday, the Public Health Agency of Canada said that there was an “urgent need” to increase vaccinations among Canadians aged 18 to 39 to reduce the risk that hospitals will become overwhelmed. It noted that there was an immediate “window of opportunity” to slow transmissions.Sixty-eight percent of all Canadians are fully vaccinated, and 75 percent have received at least one dose, according to The New York Times database. By comparison, only 53 percent of Americans are fully vaccinated and 62 percent have received at least one dose.Among those Canadians eligible for the vaccine, aged 12 and over, 77 percent are fully vaccinated. However, the rate is much lower for people in their 20s and 30s. Health officials say about 63 percent of people aged 18 to 29 have received both doses, while 68 percent of adults in their 30s are fully inoculated.As it has in other countries, the highly contagious Delta variant has driven up cases and hospitalizations in Canada in recent weeks. On Thursday, the seven-day average of new cases in Canada was 3,489, up 56 percent from two weeks earlier, according to the Times database. Deaths rose 8 percent over the same period.Hospitalizations were also up 34 percent over the last week and were dominated by unvaccinated patients, the country’s chief public health officer, Dr. Theresa Tam, said in a statement.The upward trend could climb to more than 15,000 cases a day by October if vaccination rates don’t rise, the agency’s modeling showed. But, the increase in cases could also be curbed if other public health measures succeed in reducing transmissions by 25 percent, the agency said.Some provinces could achieve this by restricting access to a number of public settings to the fully vaccinated. Both Quebec and Manitoba began vaccine passport systems this week, requiring individuals to present an electronic or physical proof of vaccination to enter certain places, including restaurants. British Columbia and Ontario are scheduled to impose similar restrictions later this month.The Ontario government announced its vaccine passport system on Wednesday. The next day, bookings by people seeking the shots more than doubled, the provincial health minister, Christine Elliott, said on Twitter. “Today, we’re already seeing thousands more Ontarians roll up their sleeves, nearly half of whom are receiving their first dose,” she said.Other provinces have gone in a different direction.Alberta, which does not have a vaccine passport system, on Friday reinstated an indoor mask requirement and announced a cash incentive of 100 Canadian dollars on a prepaid debit card for people over 18 who get vaccinated by Oct. 14. The province has also awarded the second of three lottery prizes of one million Canadian dollars each to spur inoculations, and dozens of other smaller prizes. The province has the highest rate of active coronavirus cases in the country, according to national public health data.Oscar De La Hoya signed autographs at a media promotion last month in Los Angeles.Caroline Brehman/EPA, via ShutterstockOscar De La Hoya, the aging hall of fame boxer, said he has been hospitalized with Covid-19 and he will not take part in a comeback fight planned for later this month.Mr. De La Hoya, 48, posted videos on Instagram and Twitter on Friday of himself in a hospital bed in Los Angeles. He says in Spanish to the camera that had been diagnosed with Covid-19 even though he was fully vaccinated.“Me siento mal, mal, mal, mal, tengo Covid, mi pecho no — no puedo respirar bien.” “I feel bad, bad, bad, bad, I have Covid, my chest doesn’t — I can’t breathe well.”The boxer, who retired with a 39-6 professional record and won numerous world titles, hasn’t fought in a professional boxing match since he lost to Manny Pacquiao in 2008. Mr. De La Hoya had been training in recent months for an match against Vitor Belfort, a former UFC champion, on Sept. 11 at the Staples Center in Los Angeles.In recent years, Mr. De La Hoya, whose nickname was “Golden Boy,” has worked as a boxing promoter and last year helped push to bring boxing back during the pandemic, even if it meant there would be no fans in the arena. He will be replaced in the fight by Evander Holyfield, ESPN reported.Masha Crawford, a nurse, tends to a patient on dialysis at Providence St. John’s Health Center in Los Angeles. People hospitalized with Covid-19 are at greater risk of kidney damage, a new study finds.Isadora Kosofsky for The New York TimesSince the beginning of the pandemic, doctors have found that people who become very ill with Covid-19 often experience kidney problems, not just the lung impairments that are the hallmark of the illness.Now, a large study suggests that kidney issues can last for months after patients recover from the initial infection, and may lead to a serious lifelong reduction of kidney function in some patients.The study, published Wednesday in the Journal of the American Society of Nephrology, found that the sicker Covid patients were initially, the more likely they were to experience lingering kidney damage. But even people with less severe initial infections could be vulnerable.“You see really, across the board, a higher risk of a bunch of important kidney-associated events,” said Dr. F. Perry Wilson, a nephrologist and associate professor of medicine at Yale, who was not involved in the study. “And what was particularly striking to me was that these persisted.”Kidneys play a vital role in the body, clearing toxins and excess fluid from the blood, helping maintain a healthy blood pressure, and keeping a balance of electrolytes and other important substances. When the kidneys are not working properly or efficiently, fluids build up, leading to swelling, high blood pressure, weakened bones and other problems. The heart, lungs, central nervous system and immune system can become impaired. In end-stage kidney disease, dialysis or an organ transplant may become necessary. The condition can be fatal.The new study, based on records of patients in the Department of Veterans Affairs health system, analyzed data from 89,216 people who tested positive for the coronavirus between March 1, 2020, and March 15, 2021, as well as data from 1,637,467 people who were not Covid patients.Between one and six months after becoming infected, Covid survivors were about 35 percent more likely than non-Covid patients to have kidney damage or substantial declines in kidney function, said Dr. Ziyad Al-Aly, chief of the research and development service at the V.A. St. Louis Health Care System and senior author of the study.A man receiving a third shot of the Pfizer-BioNTech vaccine last month in Southfield, Mich., after the F.D.A. and the C.D.C. said that some immunocompromised people needed an additional shot to attain protection against severe Covid. Emily Elconin/Getty ImagesTop federal health officials have told the White House to scale back a plan to offer coronavirus booster shots to the general public later this month, saying that regulators need more time to collect and review all the necessary data, according to people familiar with the discussion.Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, and Dr. Rochelle P. Walensky, who heads the Centers for Disease Control and Prevention, warned the White House on Thursday that their agencies may be able to determine in the coming weeks whether to recommend boosters only for recipients of the Pfizer-BioNTech vaccine — and possibly just some of them to start.The two health leaders made their argument in a meeting with Jeffrey D. Zients, the White House pandemic coordinator. Several people who heard about the session said it was unclear how Mr. Zients responded. But he has insisted for months that the White House will always follow the advice of government scientists, wherever it leads.Asked about the meeting, a White House spokesman on Friday said, “We always said we would follow the science, and this is all part of a process that is now underway,” adding that the administration was awaiting a “full review and approval” of booster shots by the F.D.A. as well as a recommendation from the C.D.C.“When that approval and recommendation are made,” the spokesman, Chris Meagher, said, “we will be ready to implement the plan our nation’s top doctors developed so that we are staying ahead of this virus.”Less than three weeks ago, Mr. Biden said that, contingent on F.D.A. approval, the government planned to start offering boosters the week of Sept. 20 to adults who had received their second shot of the Pfizer-BioNTech or Moderna vaccine at least eight months ago. That would include many health care workers and nursing home residents, as well as some people older than 65, who were generally the first to be vaccinated. Administration officials have said that recipients of the single-dose Johnson & Johnson vaccine would probably be offered an additional shot soon as well.Prescriptions for ivermectin have jumped to more than 88,000 per week in the United States.Luis Robayo/Agence France-Presse — Getty ImagesPrescriptions for ivermectin, a drug typically used to treat parasitic worms that has repeatedly failed in clinical trials to help people infected with the coronavirus, have risen sharply in recent weeks, jumping to more than 88,000 per week in mid-August from a prepandemic average of 3,600 per week, according to the Centers for Disease Control and Prevention.Ivermectin was introduced as a veterinary drug in the late 1970s, and the discovery of its effectiveness in combating certain parasitic diseases in humans won the 2015 Nobel Prize for medicine.Though it has not been shown to be effective in treating Covid-19, people are now clamoring to get the drug, trading tips in Facebook groups and on Reddit. Some physicians have compared the phenomenon to last year’s surge of interest in hydroxychloroquine, though there are more clinical trials evaluating ivermectin.While sometimes given to humans in small doses for head lice, scabies and other parasites, ivermectin is more commonly used in animals. Physicians are raising alarms about a growing number of people getting the drug from livestock supply centers, where it can come in highly concentrated paste or liquid forms.Calls to poison control centers about ivermectin exposures have risen significantly, jumping fivefold over their baseline in July, according to C.D.C. researchers, who cited data from the American Association of Poison Control Centers. Mississippi’s health department said this month that 70 percent of recent calls to the state poison control center had come from people who ingested ivermectin from livestock supply stores.Clinicians suiting up at a free Covid-19 testing site in Oakland, Calif. Fewer Covid-related medical services will be free in the future.Jim Wilson/The New York TimesAmericans will most likely pay significantly more for Covid medical care during this new wave of cases — whether that’s a routine test or a lengthy hospitalization.Earlier in the pandemic, most major health insurers voluntarily waived costs associated with Covid treatment. Patients weren’t responsible for co-pays or deductibles for emergency room visits or hospital stays, and most tests were free, too. But now, insurers are treating Covid more like other conditions, no longer fully covering the costs of care.The federal rules that make coronavirus testing free include exemptions for routine workplace and school testing, which has become more common. Some patients have already received bills as high as $200 for routine screenings, according to documents patients submitted to a New York Times project tracking the costs of Covid testing and treatment. If you’ve received a bill, you can submit it here.Some of the highest bills will probably involve Covid patients who need extensive hospital care now that 72 percent of large health plans are no longer offering free Covid treatment, a recent study from the Kaiser Family Foundation found.This includes Blue Cross Blue Shield of Florida, the largest health plan in a state experiencing one of the country’s worst outbreaks. “When the Covid-19 pandemic began last year, we implemented several emergency provisions to temporarily help our members,” Toni Woods, a spokeswoman, said in a statement. She said the plan was now focused on encouraging vaccinations.Oscar Health, which sells coverage in Florida and 14 other states, also ended free Covid treatment this week. It cited the widespread availability of the vaccine as a key reason. Jackie Khan, an Oscar spokeswoman, said, “We believe that the Covid vaccine is our best way to beat this pandemic, and we are committed to covering it and testing at $0 for our members.”The new policies generally apply to all patients, including the vaccinated, people who get sick with a breakthrough infection, and children under 12, who are not yet eligible for the vaccine.Dr. Kao-Ping Chua, a pediatrician at the University of Michigan who researches Covid care costs, said, “If you have a small kid who gets Covid at school and ends up at the I.C.U., that family is going to now be stuck with the bill even though that patient did not have the ability to get vaccinated.”