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WARH has largest number of COVID-19 patients yet

Surrounding states are calling hospitals here to find beds for COVID 19 patients, but in the Appalachian Regional Healthcare System at least there are not enough beds to take them.

As of Monday, the ARH system had 115 COVID patients with 25 of those in intensive care. Patients range in age from their 20s up, with more than half under the age of 60. At least one patient about 23 years of age from Letcher County is on a ventilator.

“We have 14 COVID-positive patients in Whitesburg right now,” Whitesburg ARH Community Chief Executive Officer Dena Sparkman said Monday. “That’s higher than we have ever been anytime in this pandemic.” Sparkman said the surge in COVID cases shows no sign of abating. The hospital has been seeing people be admitted to the hospital about two weeks after testing positive as outpatients.

“The outpatient numbers are still climbing,” she said.

Virtually none of the patients that have been hospitalized have been vaccinated.

“We have only had one inpatient who has been vaccinated, and nobody who has been vaccinated has been in our ICU (intensive care unit),” Sparkman said.

Systemwide, 97 percent of ARH’s COVID patients have been unvaccinated, according to a Facebook post by Dr. Maria Braman, chief medical officer for ARH.

“This weekend, ARH has received calls from Louisiana, Alabama and Mississippi looking for ICU beds for COVID+ patients,” Braman wrote in a post that was shared across Facebook by others. “We cannot take them because our ICU beds are filling up.”

Kentucky Gov. Andy Beshear said Tuesday that there are only two ICU beds left in all of Alabama, and Mississippi on Tuesday reported it’s fifth pediatric death from COVID-19 since the pandemic began.

Braman said in her post that 53 percent of the ARH patients were under 60. Three patients admitted last week were 18-19 years old and five were 20-29, something she said they have never seen before.

“I am terrified that our health care systems will be overwhelmed in the weeks and months to come,” Braman wrote. “I have no political agenda. I am trained to heal and care for those that are suffering. This is my life’s work and my passion. Please get vaccinated and wear a mask. We have already lost too many people.”

The story is the same across the nation. There are currently more COVID cases in Florida than in the rest of the country combined, and in Dallas County, Texas, there are no pediatric ICU beds.

Dallas County Judge Clay Jenkins broadcast a message to parents on Friday telling them that if their child needs an ICU bed, “Your child will wait for another child to die.”

Dr. Steven Stack, Kentucky Commissioner of Public Health, said hospitals across the state have begun canceling and postponing non-urgent, but important, surgeries and other procedures that would require admission to the hospital for overnight stays. He added that larger receiving hospitals in Kentucky are receiving calls from hospitals in Louisiana and Alabama seeking ICU beds to transfer patients to them; and reports from Oklahoma, Texas, Mississippi, Missouri and Louisiana are that there are no beds available in these states.

“Critical access hospitals in Kentucky are beginning to report difficulty getting their patients accepted at larger hospitals in Kentucky,” Stack said. “In one instance, a hospital called 10 other hospitals and was unable to receive an accepting hospital to take their patient.”

Sparkman said that until now, the pandemic has never forced Whitesburg ARH to keep admitted patients in the emergency room because of a lack of beds in the hospital. Now it is keeping them there until someone is released, and is using managers and other degreed staff to help with nursing duties.

She said the hospital has no specific pediatric beds left, though it could use any bed for pediatric patients if necessary.

“We are not equipped for pediatric ICU,” she said.

As of Tuesday, Letcher County had a total of 2,418 cases, up 123 from a week before. The seven-day rolling average incident rate was 78.9 per 100,000.

Just 39.9 percent of the total population in the county have been fully vaccinated and 45 percent have received at least one dose. Of children over 12, 46.5 percent have been fully vaccinated and 52.5 percent have received at least one shot. In the 18 and up age group, 49.4 percent have been fully vaccinated and 54.9 percent have at least one dose. Among those 65 and over, 67.5 percent have been fully vaccinated and 70.7 percent have received at least one shot.

The state announced today that it is recommending people who are immunocompromised get a third shot at least 28 days after a second dose.

Dr. Stack said Kentuckians with the following conditions should consider receiving a third dose:

• Active or recent treatment for cancer/malignancy;

• Solid-organ or hematopoietic stem cell transplants;

• Moderate or severe primary immunodeficiency (such as Di- George syndrome or Wiskott- Aldrich syndrome);

• Advanced or untreated HIV infection; and

• Active treatment with highdose corticosteroids, alkylating agents, antimetabolites, tumornecrosis (TNF) blockers and other immunosuppressive medications.

“This is for individuals who may not have received adequate protection from their initial primary vaccine series. People with normal immune systems are not advised to receive an additional dose at this time,” Stack said. “Anyone with questions about their eligibility should talk with their health care provider.”

Experts are not recommending a booster dose for those who received a Johnson & Johnson (Janssen) vaccine. Third doses of either the Pfizer or Moderna vaccine can be received from any COVID-19 vaccine provider that stocks the same mRNA vaccine that was used for an individual’s primary series of shots.

The Letcher County Health Department opened its $6 million health center in June 2009, moving from a 5,500-square-foot building that the department built in 1961 and paid for with a 10-cent per $100 tax. Now it is struggling to pay the payments on the new building and so far, renting the building hasn’t worked out.

It rents space to the Letcher County Commonwealth’s Attorney and to a psychologist, but that leaves large portions of the building unoccupied. Former Supreme Court Justice Sam Wright had office space in the building for about a year, but he did not win the next election. Wright moved out and the Administrative Office of the Courts stopped paying rent for that office space since the new justice lives and works more than 100 miles away.

At least two state agencies have considered renting space in the building over the past several years, but neither located there. The latest one to express an interest now has most of its employees working from home because of COVID and no longer needs the space, Collins said.

Collins said he doubts the building could be sold given that there are other buildings in the community that are sitting empty.

“ The bottom line is, we’re stuck,” Collins said.

In addition to the tax rate issue, the county lost $77 million in assessment a few years ago when the oil and gas industry finished major drilling and moved out of the county. Property Valuation Administrator Ricky Rose said that one industry cost every taxing district in the county. At its rate of 8 cents per $100, the health department lost more than $61,000. In addition the mineral tax assessment has dropped to nearly zero because of the decline in demand for coal, which Rose said he does not expect to increase again.

While mineral taxes declined, he said the remainder of the assessments have gone up every year, but not enough to compensate for the other losses. Real estate, Rose said, is increasing.

“Our sales are ungodly,” Rose said. “Instead of coal miners, it’s nurses and doctors and nurse practitioners, and they’re making more money than a coal miner ever thought about.”

Collins said many of the services the health department used to provide were moved to primary care providers and rural health centers such as Mountain Comprehensive Health Corp. by the Affordable Care Act and the money went with those services. The Letcher County Health Department now has only one nurse, when it used to have six. Well-child visits, Women with Infant Children program visits, and health inspections are the only things left in the health department, Collins said.

“We don’t do anything anymore that we used to do,” he said.

Collins and Lockard both said the district is limited by state law to a 10-cent per $100 tax rate, and that amount would not address the current needs. Collins said even with tax assessments on real estate up, the district doesn’t see much benefit because so many people can’t afford to pay, and companies that used to buy up delinquent tax bills aren’t interested anymore.

As of the last tax year, Letcher County Sheriff Mickey Stines said his department collected 90 percent of the taxes levied. That includes privately owned property. Property owned by government agencies, churches and non-profit entities do not receive tax bills.

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