The Whitesburg Appalachian Regional Hospital is now treating some high-risk COVID-19 outpatients with an experimental drug that received Food and Drug Administration emergency use approval two weeks ago.
Hospital Chief Executive Officer Dena Sparkman said the first patient received an intravenous (IV) infusion of the drug Bamlanivimab last Friday, and the patient has responded well. The hospital will bill for the infusion, but not for the drug itself.
“We were told that that drug would be given at no charge,” Sparkman said. “It’s an IV infusion. It takes about an hour, and there is about an hour monitoring after you receive the drug.”
Patients must meet certain criteria before they can receive Bamlanivimab: They must be over 12 years old and over 88 pounds, must not be in the hospital, must have tested positive for COVID-19 with a “PCR” test (a test that takes approximately 48 hours for results), and they must have received and read a fact sheet about the drug telling them that it has not been approved, and telling them about alternatives.
Patients must also have a high-risk factor such as obesity, diabetes, immunosuppressive diseases, over age 65, or over age 55 with heart disease, and must have mild to moderate symptoms of COVID-19.
Bamlanivimab is one of the experimental drugs used for President Donald Trump when he was COVID-positive.
The drug is in a class called monoclonal antibodies. It is a manmade protein that mimics the body’s own immune response, and attacks one specific part of the virus’s protein structure to prevent it from attaching to human cells.
The drug is not a vaccine – Spark- man said meetings have been scheduled for next week to discuss distribution of those – and it’s not for patients sick enough to require hospitalization. The antibody treatment has not been shown to help patients with severe symptoms, and could actually make patients on high-flow oxygen or ventilators worse.
But research has shown the drug makes it less likely that patients who test positive and are at high risk will get worse and become hospitalized. That is important not just for the obvious health benefits to the person receiving the drug, but also because officials are worried that a spike in coronavirus infections after Thanksgiving could overwhelm hospitals.
Kentucky Gov. Andy Beshear on November 18 issued an executive order placing new restrictions on some businesses and on schools.
Under the new executive order, which Beshear said was written in consultation with the Kentucky Commissioner of Education, the chairman of the Kentucky Board of Education and the Kentucky High School Athletic Association, schools were closed to in-person instruction beginning Monday and will remain closed until January 4.
Elementary schools may reopen December 7, if the county in which they are located is not in the “Red Zone,” meaning an incident rate of 25 per 100,000 or greater.
As of Monday, only three Kentucky counties were not in red.
The KHSAA has suspended fall sports and practices at Kentucky schools until after December 13.
Gymnasiums, pools, bowling alleys and similar facilities are reduced to 33 percent capacity beginning Friday, November 20, at 5 pm. and will remain restricted until December 13. That means no group classes, though individual training will be allowed if participants wear masks.
Other indoor venues will be restricted to no more than 25 people.
Restaurants and bars will again be closed to indoor dining, but outdoor dining, take-out and delivery will be allowed. That restriction is also from 5 p.m. Friday until 11:59 p.m. December 13.
Beshear announced a $40 million fund to assist restaurants and bars that are struggling financially as a result of the restrictions.
Other businesses are being asked to close “if possible,” and to allow employees to work from home whenever they can. He asked that the number of employees inside offices be limited to 33 percent of those who would normally be there.
The Chief Justice of Kentucky John Minton has also ordered court facilities closed and suspended jury trials until February 1.
Beshear also asked that residents forego any large gatherings, and that Thanksgiving dinners include no more than two households with a maximum of eight people gathering at once.
The Centers for Disease Control has urged Americans not to travel for Thanksgiving, but airlines are reporting high traffic.
Beshear said last week that more than 9 percent of people tested for the virus in Kentucky are testing positive. In New York, where the rate is about a third of that in Kentucky, businesses have already been ordered closed. The Governor said over the weekend that while hospitals may run out of beds because of COVID, they may run out of nurses first. Those in the healthcare field are expected to receive the vaccine first, along with high-risk people such as those in nursing homes.
While hospitals in some other states are already rationing care, it has not yet reached that point here.
“So far, we are OK. We have prepared. We’re not overflowing, as some hospitals are,” Sparkman said. “We are not at capacity in our ICU (intensive care unit), and we also have a plan to expand the ICU as needed. ICU is not really about the rooms, it’s more about the people who are actually caring for the patient. We have six beds in our ICU and we have a plan to expand to a total of 10 if it’s needed.”
Statewide, Kentucky set yet another record for COVID 19 cases for the week, surpassing the previous record by 3,766, according to the governor’s office. As of Monday morning, 117 of the state’s 120 counties were in the red zone, meaning their average infection rates for the previous seven days were above 25 cases per 100,000 people. Letcher County’s rate was 43.1 cases per 100,000. Only Rockcastle, Menifee and Nicholas counties remained below a rate of 25.
In Letcher County, the number of positive COVID 19 cases was 433 on Monday, according to a count maintained by the Kentucky River District Health Department, up from 393 on the previous Tuesday. Of those, 17 were confirmed on Monday, including two under the age of 18, and ranging up to 77. State figures are considerably higher, showing Letcher County with 467 cases. District Director of Public Health Scott Lockard said figures go to the state first, and then to the district, creating a delay in the numbers. He said the district then does contact tracing and checks for duplicates before posting numbers.
Lockard said the number of cases has overwhelmed the district’s 14 contact tracers, and other employees have been pulled from their regular duties to help. While contact tracers are talking to everyone who tests positive, the process can take up to two hours per person. Because of that, the district can’t call everyone with whom every positive case has been in contact.
“We’re contacting all the cases right now, but we’re trying to give them the tools they need to make good decisions and reach out to everyone they have had contact with,” Lockard said.
Anyone who has been exposed is asked to self-quarantine for 14 days and call their work, school, family members and others they might have been in contact with. Those who test positive are asked to do the same, and anyone who tests positive should stay away from the people they live with, even using a separate bathroom, if possible. Guidance from the health department says those testing positive should not let others into their home during the quarantine, and should not go out anywhere. It advises asking a friend or family member who is not in the household to get groceries and other needs and leave them outside for the quarantined person to pick up.
Persons who experience fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, congestion or runny nose, new loss of taste or smell, headache, sore throat, nausea or vomiting, or diarrhea should call their family doctor and get tested.
Total numbers of cases for Letcher and the surrounding counties are as follows: Knott – Total 506 (49 probable) (96 active, 400 recovered, 10 deceased); Lee – Total 288 (44 probable) (99 active, 176 recovered, 13 deceased); Leslie – Total 196 (14 probable) (39 active, 156 recovered, 1 deceased); Letcher – Total 433 (144 probable) (89 active, 342 recovered, 2 deceased); Owsley – Total 168 (65 probable) (63 active, 104 recovered, 1 deceased); Perry – Total 831 (68 probable) (193 active, 628 recovered, 10 deceased); Wolfe – Total 153 (40 probable) (57 active, 95 recovered, 1 deceased)
Pike – Total 1,647 (State Department of Health Number, 17 dead); Harlan – Total 833 (16 dead); Wise Co., Va. – Total 1,138 (59 hospitalized, 36 dead); Norton, Va. – Total 71 (5 hospitalized).