Coronavirus (COVID-19) Updates

September 17, 2020

This is our twenty-seventh weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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September 10, 2020

This is our twenty-sixth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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September 3rd, 2020

This is our twenty-fifth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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August 27, 2020

This is our twenty-fourth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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August 20, 2020

This is our twenty-third weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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August 13, 2020

This is our twenty-second weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
  • Midwest
    • The Midwest continues to see a rise in coronavirus cases. 
  • Progress on vaccine research and testing
    • A number of potential coronavirus vaccines have advanced to later phases of testing. A few have started Phase III Efficacy Trials, in which vaccines are given to thousands of people and placebos are given to others, and researchers wait to see how many people given the vaccine get infected versus those given a placebo. 
    • One of these trials receiving the most press attention in the United States is being conducted by Moderna and the National Institutes of Health. The first Phase III trial began on July 27. Eventually, around 30,000 people will be enrolled in the trial. 
    • See an overview of all potential vaccines and their relative progress in this tracker by the New York Times. 
    • In the United States, the FDA previously released a statement in June that any vaccine would need to protect at least 50% of people to be considered effective. 
    • On August 11, the U.S. Department of Health and Human Services (HHS) and Department of Defense (DoD) announced an agreement with Moderna, Inc. to manufacture and deliver 100 million doses of the company’s COVID-19 vaccine candidate. Read more here
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. See the full list here.
    • On August 11, allowed bars to reopen at 50% capacity and restaurants to increase capacity back to 50% for indoor dining. There will be an 11pm closing time mandated, with food and drink service having to end at 10pm. 
    • On August 10, recommended that school districts delay in-person learning until at least September 28. 
    • On August 6, extended the mask mandate for an additional 30 days. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • Read documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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August 6, 2020

This is our twenty-first weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
    • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Midwest
    • The Midwest continues to see a rise in coronavirus cases, with Montana, Oklahoma, and Missouri experiencing some of the largest increases in percentages of infections in the past week or so. 
  • Progress on vaccine research and testing
    • A number of potential coronavirus vaccines have advanced to later phases of testing. A few have started Phase III Efficacy Trials, in which vaccines are given to thousands of people and placebos are given to others, and researchers wait to see how many people given the vaccine get infected versus those given a placebo. 
    • One of these trials receiving the most press attention in the United States is being conducted by Moderna and the National Institutes of Health. The first Phase III trial began on July 27. Eventually, around 30,000 people will be enrolled in the trial. 
    • See an overview of all potential vaccines and their relative progress in this tracker by the New York Times. 
    • In the United States, the FDA previously released a statement in June that any vaccine would need to protect at least 50% of people to be considered effective. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. See the full list here.
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On July 30, Governor Holcomb ordered all counties in Indiana to extend Stage 4.5 of reopening to August 27. He also extended the prohibition on residential rental property evictions and mortgage foreclosures. He additionally ordered that all public and private K-12 schools have all students, staff, faculty, volunteers, vendors, and visitors wear a face covering or shield when on school grounds or in school buildings and facilities. Read the order here
      • Read documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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July 30, 2020

This is our twentieth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of July 28, 52,942,145 total viral tests have been reported and 5,046,506 positive viral tests have been reported in the United States. This is a 10% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Midwest at risk of surge in cases
    • Kentucky, Indiana, Ohio, and Tennessee are showing warning signs of potential surges in coronavirus cases. Positive case numbers and positivity rates have been rising significantly in all three states over the past few weeks. 
    • Dr. Deborah Birx, White House coronavirus response coordinator, visited Kentucky on July 26 and recommended that the state close bars and reduce restaurant capacity to curb a potential surge. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On July 27, Governor Beshear announced new measures to curb a rising number of coronavirus cases in Kentucky. He announced that bars would close for two weeks starting July 28 and restaurant indoor capacity would be reduced to 25% of pre-pandemic capacity. He also recommended public and private schools avoid in-person instruction until the third week of August. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On July 24, Governor Holcomb issued a 30 day statewide mask order in effect starting July 27. All Indiana residents 8 and older are required to wear a face covering in indoor public spaces, outdoor public spaces where social distancing isn’t possible, and while using public transportation. Read the order here
      • Read documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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July 23, 2020

This is our nineteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of July 22, 51,680,022 total viral tests have been reported and 4,878,379 positive viral tests have been reported in the United States. This is a 10% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Emerging research
    • There is emerging evidence that the coronavirus can spread through small particles in the air. These smaller particles, which can spread when people talk or breathe, were previously not thought to be the main method of transmission- larger respiratory droplets from coughs and sneezes were. This research may change recommendations and guidelines for masking and distancing in indoor spaces. Read more here
  • Increasing case numbers across the United States
    • The United States has seen coronavirus cases surge in recent weeks, with particularly high rates of increase in Southern and Western states including Florida, California, Arizona, and Texas. The seven day average of new cases across the United States stands just over 66,000.
  • Kentucky
    • Cases have started to rise significantly in Kentucky over the past two weeks, with the total case number growing past 24,000 and some of the highest single day case increases being recorded. 
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On July 20, the Kentucky Department of Public Health issued a new travel advisory that recommends a 14-day self-quarantine for travelers who went to any of eight states – Alabama, Arizona, Florida, Georgia, Idaho, Nevada, South Carolina and Texas – that were reporting a positive coronavirus testing rate equal to or greater than 15%. The advisory also includes Mississippi, which is quickly approaching a positive testing rate of 15%, and the U.S. Territory of Puerto Rico. Read more here
      • On July 20, the Cabinet for Health and Family Services issued a new order that pulls back on guidance covering social, non-commercial mass gatherings. On June 29, the original guidance was eased to allow for gatherings of 50 or fewer people. The new order returns the guidance to allow only for such gatherings of 10 or fewer people. The guidance, which does not apply to weddings, restaurants, retail or other public venues, went into effect on July 20 at 5 p.m. Read the order here
  • Indiana
    • Indiana has also started to see a rise in coronavirus cases after weeks of slow decline. 
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On July 16, Governor Holcomb ordered a continuation of Stage 4.5 of reopening Indiana (except for Elkhorn County) in light of increased coronavirus spread. This extension pushes Stage 5 to August 1. Read more here
      • Read documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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July 16, 2020

This is our eighteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of July 14, 41,761,392 total viral tests have been reported and 3,754,729 positive viral tests have been reported in the United States. This is a 9% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Emerging research
    • There is emerging evidence that the coronavirus can spread through small particles in the air. These smaller particles, which can spread when people talk or breathe, were previously not thought to be the main method of transmission- larger respiratory droplets from coughs and sneezes were. This research may change recommendations and guidelines for masking and distancing in indoor spaces. Read more here
  • Increasing case numbers across the United States
    • The United States has seen coronavirus cases surge in recent weeks, with particularly high rates of increase in Southern and Western states including Florida, California, Arizona, and Texas. The seven day average of new cases across the United States stands just over 60,000, over three times higher than new case averages a month ago. 
  • Kentucky
    • Cases have started to rise significantly in Kentucky over the past week, with the total case number growing past 20,000 and some of the highest single day case increases. 
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On July 14, reminded Kentuckians that they can report noncompliance with coronavirus mandates through the reporting hotline at 833-KY SAFER (833-597-2337) or online at https://govstatus.egov.com/kysafer
      • On July 10, the Cabinet for Health and Family Services Department for Public Health issued an order related to health insurers and licensed clinician’s COVID-19 testing. Read the order here
      • On July 9, signed an executive order requiring Kentuckians to wear face coverings under several circumstances for the next 30 days. There are several exemptions to the order, including children who are 5 or younger and any person with a disability or a physical or mental impairment that prevents them from safely wearing a face covering. Read the order here
  • Indiana
    • Indiana has also started to see a rise in coronavirus cases after weeks of slow decline. 
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On July 8, issued a coronavirus screening guide for parents to use each day before school to help them decide if they need to keep their child/children home. Read the guide here
      • On July 7, issued guidance on when students, faculty, and staff can return to school after showing symptoms. 
      • Read documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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July 9, 2020

This is our seventeenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of July 9, 39,208,278 total viral tests have been reported and 3,487,780 positive viral tests have been reported in the United States. This is a 9% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Emerging research 
    • There is emerging evidence that the coronavirus can spread through small particles in the air. These smaller particles, which can spread when people talk or breathe, were previously not thought to be the main method of transmission- larger respiratory droplets from coughs and sneezes were. This research may change recommendations and guidelines for masking and distancing in indoor spaces. Read more here
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On June 30, ​announced that the deadline to apply for Pandemic-Electronic Benefits Transfer (P-EBT) has been extended until the end of August. P-EBT provides equivalent funding for meals that students would have been provided in school this spring without the closures due to COVID-19. Read more here.
      • On June 30, ​announced Kentuckians who are uninsured can apply for short-term coverage through Medicaid Presumptive Eligibility. Families can apply online at chfs.ky.gov or benefind.ky.gov, by contacting an application assistant at healthbenefitexchange.ky.gov or by calling 855-459-6328. Initial coverage ends two months after the application month, unless the person applies for regular Medicaid or Presumptive The state is extending Presumptive Eligibility benefits for three months for anyone who already applied and whose coverage was previously set to end June 30. Read more here
      • On June 30, announced the state has hired Ernst & Young to help begin immediately processing outstanding claims that resulted from the COVID-19 global pandemic. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On July 6, created a COVID-19 Screening Decision Tree for schools as they prepare to reopen. See the document here
      • On July 1, announced Indiana would delay its transition to stage 5 of reopening. Instead, starting on July 4 and continuing through July 17 (for all counties except Elkhart), Indiana will enter phase 4.5. Phase 4.5 is similar to phase 4, and is intended to pause reopening plans as coronavirus cases increase around the nation. Read the Executive Order here
      • See documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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July 2, 2020

This is our sixteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of July 1, 33,601,847 total viral tests have been reported and 3,194,381 positive viral tests have been reported in the United States. This is a 10% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On June 29, visitation resumed at assisted living and personal care homes, group activities (10 or fewer) in facilities, communal dining and off-site appointments. On July 15, visitation will resume in nursing homes and in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs).
      • On June 24, Governor Beshear, Lieutenant Governor Jacqueline Coleman and Kevin Brown, interim commissioner of the Kentucky Department of Education, released initial guidance for Kentucky schools looking ahead to opening in the fall. Read the guidance here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On June 29, issued guidance and timelines for visitation in Long-term Care Facilities. Read the guidance here
      • On June 26, created an FAQ document regarding COVID-19 planning for schools and local health departments. Read the document here
      • See documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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June 25, 2020

This is our fifteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of June 23, 30,110,061 total viral tests have been reported and 2,874,748 positive viral tests have been reported in the United States. This is a 10% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On June 22, ​announced updated guidance beginning next week for many venues, including restaurants and bars. Read the requirements for restaurants and bars here. The new guidance also covers wedding venues and gatherings of 50 or fewer people. Read the requirements for gatherings of 50 or fewer people here
      • On June 18, ​announced the state would continue to expand in-person services to help Kentuckians resolve unemployment insurance claims. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On June 19, issued guidance on reducing indoor COVID-19 transmission through changing environmental factors. Read the guidance here
      • On June 18, updated guidance on making and wearing masks in public. Read the guidance here
      • See documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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June 18, 2020

This is our fourteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of June 16, 23,765,801 total viral tests have been reported and 2,523,345 positive viral tests have been reported in the United States. This is a 11% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On June 16, gave updated guidance on public pools and gatherings of up to 50 people. Read the pool guidance here and the guidance on gatherings here
      • On June 15, ​announced that Kentucky is currently performing mass testing of all inmates and staff members at the Kentucky Correctional Institute for Women (KCIW) in Shelby County. TThree staffers and 11 inmates recently tested positive for COVID-19. More than 270 of the facility’s 639 inmates have been tested thus far. Fortunately, no one from the facility has been hospitalized. Read more here
      • On June 15, announced that contact tracers will call people who may have been exposed from 1-844-KYTRACE (1-844-598-7223) to offer information and resources to keep them and others safe. Read more here
      • ​On June 10, announced churches, synagogues, mosques and other houses of worship can begin hosting congregants at 50% of their pre-pandemic capacities. Read the guidelines here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On June 15, updated the Specimen Submission and Collection Guidelines. See the updated guidelines here
      • On June 12, announced the beginning of Stage 4 of reopening Indiana. Stage 4 will span June 12-July 3. Read the Executive Order here
      • See documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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June 11, 2020

This is our thirteenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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June 4, 2020

This is our twelfth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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May 28, 2020

This is our eleventh weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of May 26, 15,183,888 total viral tests have been reported and 1,858,968 positive viral tests have been reported in the United States. This is a 12% positive rate. 
      • Viral tests tell you if you are currently infected. These differ from antibody blood tests; antibody tests check your blood by looking for antibodies, which show if you had a previous infection with the virus.
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On May 22, announced a new absentee ballot portal that is live online here. Voters in every county of the commonwealth can request a mail-in ballot for the June primary elections. The last day to apply for a ballot is June 15. The primary elections in Kentucky will be held on June 23.
      • On May 22, lifted the interstate travel ban. See the executive order here in English or here in Spanish. 
      • On May 21, provided an updated Healthy at Work schedule for June. See the full schedule here
      • On May 20, announced a $300 million award to city and county governments as part of the Coronavirus Aid, Relief and Economic Security (CARES) Act. The CARES Act established the Coronavirus Relief Fund (CRF) to reimburse local governments for expenses incurred in response to the public health emergency caused by COVID-19. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On May 21, announced that Stage 3 of Indiana’s opening would begin on May 22 for most of the state; Cass, Lake, and Marion counties, the hardest hit areas of the state, will enter Stage 3 later on June 1. Read more about Stage 3 here
      • See documentation on Indiana’s 5 stages of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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May 21, 2020

This is our tenth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of May 19, 12,601,143 total viral tests have been reported and 1,699,375 positive viral tests have been reported in the United States. This is a 13% positive rate. 
      • Viral tests tell you if you currently are infected. 
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On May 19, announced that museums, outdoor attractions, aquariums, libraries and distilleries will be allowed to reopen with proper distancing and sanitization procedures in place starting June 8.
      • On May 18, announced the appointment of Mark Carter as executive adviser leading the contact tracing efforts in the Office of the Secretary of the Cabinet for Health and Family Services (CHFS). Learn more about contact tracing in a video here
      • On May 14, announced that groups of 10 or fewer may gather again starting May 22 and the travel ban will expire on May 22. Read more here
      • On May 13, announced the next step for health care reopening. Hospitals and care facilities can begin non-emergency surgeries and procedures at 50% of their pre-COVID-19-era patient volume beginning May 13. Facilities will determine their patient capacities starting May 27 as long as progress continues.​
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On May 18, issued COVID-19 Specimen Collection and Submission Guidelines for healthcare providers. Learn more here
      • See documentation on Indiana’s 5 phases of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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May 14, 2020

This is our ninth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of May 13, 10,217,573 total viral tests have been reported and 1,510,924 positive viral tests have been reported in the United States. That is a 15% positive rate. 
      • Viral tests tell you if you currently are infected. 
      • A single infected person may be tested multiple times, so the number of positive cases is not equal to the number of positive tests. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On May 7, announced that phase 2 of reopening the economy would start on May 22. Read more here
        • Phase 3 is planned to start on July 1. New Phase 2 reopening dates are now tentatively:
          • May 22 – Restaurants, with limited 33% capacity and outdoor seating
          • June 1 – Movie theaters, fitness centers
          • June 11 – Campgrounds, public and private
          • June 15 – Child care, with reduced capacity; and potentially low-touch and outdoor youth sports
      • On May 6, announced the beginning of Health Care reopening phase 2. This includes outpatient and ambulatory surgery and invasive procedures may resume. Read more here
      • On May 5, announced an aggressive testing plan for long-care facility staff and patients. Learn more here.
      • On May 4, announced a partnership with the Kentucky Chamber of Commerce and the Kentucky Distillers’ Association to get personal protective equipment (PPE) and hand sanitizer to small businesses as they prepare to reopen. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week:
      • On May 11, created an interactive map of public wifi locations in Indiana. See the map here
      • See documentation on Indiana’s 5 phases of reopening here
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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May 7, 2020

This is our eighth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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April 30, 2020

This is our seventh weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

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April 23, 2020

This is our sixth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

  • Confirmed cases and deaths
  • Testing
    • As of April 22, 97 public health labs in the United States have the capacity to test for the coronavirus. 
    • As of April 22, 5,116 specimens have been tested by CDC labs and 405,105 specimens have been tested by US public health labs. 
  • National
    • On April 16, the White House issued the Guidelines for Opening Up America Again, a three-phased approach to guide re-opening the economy. The guidelines outline criteria for different phases of reopening and specific guidance for employers, individuals, and state governments. Read more here
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On April 20, advised educational institutions to remain closed to in-person instruction through the rest of the school year.
      • On April 17, discussed benchmarks Kentucky must meet to re-open the economy, reflecting federal guidance from the White House on April 16. Learn more here
      • On April 16, announced Kentucky is joining a regional state partnership with Wisconsin, Illinois, Minnesota, Michigan, Ohio, and Indiana to coordinate plans to reopen regional economies when the time is right. Read more here
      • On April 15, announced the first stage of the Co-Immunity Project, a testing regime that will focus on comprehensive testing, centered on antibodies and developing donor plasma resources, starting with healthcare workers. Read more here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week (see the full list here):
      • On April 16, announced Indiana is joining a regional state partnership with Wisconsin, Illinois, Minnesota, Michigan, Ohio, and Kentucky to coordinate plans to reopen regional economies when the time is right. 
      • A full resource guide for Indiana residents is available here. Recent public updates can be found here
  • Resource List

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April 16, 2020 Coronavirus Update

This is our sixth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

Quick Facts

  • Confirmed cases and deaths
  • Testing
    • As of April 14, 95 public health labs in the United States have the capacity to test for the coronavirus. 
    • As of April 15, 5,038 specimens have been tested by CDC labs and 316,889 specimens have been tested by US public health labs. 
  • National
    • Coronavirus stimulus payments to individuals have started to arrive as direct deposits in people’s bank accounts. Paper checks may take months to arrive for people who do not have bank account information on file with the IRS. 
      • On April 15, the IRS launched an online form that allows people to upload their bank account information so they can receive their stimulus payments more quickly. See the form here
      • The stimulus amounts are $1,200 for eligible individuals and $2,400 for eligible married couples filing jointly. Read more here for information on eligibility. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On April 12, announced a partnership with Kroger that will expand testing capability in Kentucky. Locations for drive-through testing will be announced throughout the next five weeks, with a goal to perform 20,000 additional tests in five weeks. Read more here
      • On April 9, expanded who is eligible for workers compensation if they are forced to quarantine to include grocery workers, child-care workers, and more. Read more here
      • On April 8, issued an Executive Order limiting the number of people allowed in stores that are open and limiting the number of shoppers per household to one adult. Read the order here
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week (see the full list here):
      • On April 15, launched a disaster program to give residents better access to food assistance. Read more here
      • A full resource guide for Indiana residents is available here
  • Resource List

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April 9, 2020 Coronavirus Update

This is our fifth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

Quick Facts

  • Confirmed cases and deaths
  • Testing
    • As of April 8, 95 public health labs in the United States have the capacity to test for the coronavirus. 
    • As of April 8, 4,925 specimens have been tested by CDC labs and 228,034 specimens have been tested by US public health labs. 
  • National
    • On April 3, the CDC issued guidance recommending wearing cloth face coverings in public areas like grocery stores and pharmacies, and in high-transmission areas. Read more here
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights from the past week (see the full list here):
      • On April 5, announced an agreement with Gravity Diagnostics that provides up to 2,000 tests per day in Kentucky. The tests will be reserved for the area outside the ‘golden triangle’ (Louisville, Lexington, and northern Kentucky) where there is less infrastructure for testing. 
      • On April 4, adopted CDC recommendations to wear cloth face coverings in public.
      • On April 2, recommended school systems extend suspensions of in-person instruction to at least May 1. 
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights from the past week (see the full list here):
      • On April 6, issued a new two week stay at home order. Read more here
      • A full resource guide for Indiana residents is available here
  • Resource List

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April 2, 2020 Coronavirus Update

This is our fourth weekly update regarding the coronavirus (COVID-19). Below, you will find updated facts and figures. 

Quick Facts

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March 26, 2020 Coronavirus Update

This is our third weekly update regarding the novel coronavirus (COVID-19). Below, you will find updated facts and figures. 

Quick Facts

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March 19, 2020 Coronavirus Update

This is our second weekly update regarding the novel coronavirus (COVID-19). Below, you will find updated facts and figures. 

Quick Facts

  • The coronavirus causing COVID-19 has now spread to 164 locations internationally (as of 3/18/20).
  • Confirmed cases and deaths
  • Testing: As of March 16, 89 public health labs in the United States have the capacity to test for the coronavirus. 
    • As of March 17, 4,255 specimens have been tested by CDC labs and 27,623 specimens have been tested by US public health labs. 
  • If you are sick with COVID-19 or think you may be, follow these steps
    • Stay home except to get medical care. Many people with mild symptoms will be able to recover at home. 
    • Call before going to get medical care. 
    • Avoid public transportation.
    • Separate yourself from others in your home. 
    • Limit contact with pets and animals.
    • Wear a facemask if you are sick. 
    • Cover coughs and sneezes. 
    • Clean your hands often. 
    • Clean high-touch surfaces every day. 
    • Monitor your symptoms and consult with a medical professional before receiving care. 
  • Kentucky
    • The state of Kentucky’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Beshear. Here are a few highlights (see the full list here):
      • By 5pm on March 18, all public-facing businesses that can’t comply with CDC guidelines for social distancing must cease in-person operations. 
      • Restaurants and bars were ordered to close by 5pm on March 16. Food and beverage services are now restricted to carry-out, delivery, and take-out only. 
      • Primary elections have been postponed until June 23, 2020. 
      • All community gatherings are recommended to cancel or postpone.
      • All school districts were recommended to close in-person classes beginning March 16. All schools have done so and many are using e-learning technologies to continue instruction. 
      • Businesses are recommended to use telecommuting options and encourage working from home. 
      • Hospitals are recommended to cease non-elective procedures. 
  • Indiana
    • The state of Indiana’s response to COVID-19 includes both guidelines for specific groups and Executive Orders from Governor Holcomb. Here are some highlights (see the full list here):
      • Per CDC recommendations, all events with 50 or more people are advised to cancel or postpone. 
      • Restaurants and bars have been ordered to cease in-person services. Take-out and deliver services can still be provided. 
      • School districts are recommended to close. Most school districts have closed in-person learning and many are using e-learning technologies to continue instruction.
      • Hospitals are recommended to cease elective procedures. 
      • State employees are encouraged to use telecommuting options as much as possible. 
  • Resource List

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March 12, 2020 Coronavirus Update

As healthcare professionals, Gastroenterology Health Partners has a responsibility to be a trusted resource on relevant health topics for our patients. We will be posting weekly updates about COVID-19 (coronavirus) from reputable sources.

In our health care facilities, we are closely following guidance from the CDC and local and state health departments to inform our healthcare practices and procedures. With such a rapidly-evolving situation, it’s important that evidence informs our decisions and behaviors. We all have a responsibility to make the best informed decisions possible:

  • Seek out trusted, evidence-based sources of information.
  • Follow appropriate guidelines based on your individual situation and context.
  • Help stop social stigma against Chinese and Asian Americans, people who have gone through proper quarantine protocols, healthcare workers, and others who may be experiencing discrimination based on group identity.

Quick Facts

  • COVID-19 is a respiratory disease caused by a novel coronavirus that was first detected in China at the end of 2019. The coronavirus causing COVID-19 has now spread to over 100 locations internationally.
  • Confirmed cases and deaths
  • Symptoms
    • Symptoms include fever, dry cough, and shortness of breath. These symptoms may appear 2-14 days after exposure to the virus.
  • How does it spread?
    • Public health officials believe the virus spreads mainly person-to-person through respiratory droplets and mostly between people in close contact with each other (around 6 feet). It may spread via surfaces, but this is not thought to be the primary method of transmission.
  • Who is at risk?
    • Early data from people in China who contracted COVID-19 shows that older adults and people with chronic medical conditions are at a higher risk of getting very sick from COVID-19.
  • Preventing illness
    • There is no vaccine to prevent COVID-19 currently. As such, avoiding exposure to the virus is the best way to prevent illness. You should clean your hands often, avoid close contact with sick people, stay home if you are sick, cover sneezes and coughs with a tissue or your elbow, clean and disinfect frequently touched surfaces, and wear a facemask if you are sick.
  • Steps to take if you are sick
    • If you are sick and think you may have been exposed to COVID-19, and develop a cough, fever, or difficulty breathing, contact your healthcare provider immediately.
    • In general, self-isolate at home and follow other prevention guidelines when you are sick to help prevent the spread of disease.
  • Testing for COVID-19
    • As of March 10, 78 state and local public health labs across 50 states in the United States have the capacity to test up to 75,000 people (using CDC lab kits, not including commercially-available kits).
  • Resource List

Malabsorption: An Overview

Malabsorption is a condition in which a person has difficulty digesting and/or absorbing nutrients from food. Here’s what you need to know. 

Causes of Malabsorption

Malabsorption can be caused by various diseases. Typically, malabsorption involves difficulty absorbing nutrients like vitamins, fats, proteins, or sugars. Any disease that hinders the body’s ability to absorb nutrients can cause this condition. Common diseases that cause it include cystic fibrosis, lactose intolerance, celiac disease, whipple disease, crohn’s disease, an infection affecting the pancreas, HIV and AIDS, parasitic infection, and some genetic disorders. Some medications can cause the condition as well. Additionally, malabsorption can occur as a side effect of radiation treatments and surgeries that remove part of the small intestine or pancreas. 

Symptoms

Several symptoms can accompany malabsorption. These include bloating, gas, abnormal stool, and chronic diarrhea. Children with the condition may have a weight or rate of weight gain that is much lower than average, and may not grow and develop at expected rates. Adults can experience weight loss, weakness, and difficulty thinking. 

Diagnosis

Diagnosing malabsorption can involve several types of exams and tests. Doctors evaluate a patient’s medical history and symptoms to gather initial evidence. They then may pursue different testing approaches. Stool tests can measure the amount of fat in a patient’s stool to diagnose the malabsorption of fat, one of the most common symptoms of the condition. Stool samples can also be examined under a microscope to identify any undigested food fragments or parasites. Doctors may also perform blood or urine testing to detect high levels of undigested substances like Vitamin B-12 or lactose. 

Once malabsorption is diagnosed, identifying the underlying cause is an important next step. Biopsies, imaging testing (including x-rays and CT scans), and pancreatic function tests can all help identify the underlying cause. 

Treating and Preventing Malabsorption

Treatment involves both treating symptoms and treating the underlying cause of malabsorption to ensure proper nutrient absorption. Medication can treat symptoms like diarrhea. Nutrient and fluid replacement can treat nutrient deficiency and dehydration. Additionally, high-calorie diets can help the body absorb more nutrients. These diets can include varying amounts of proteins, fats, carbohydrates, and key vitamins and minerals. Injections of vitamins and minerals can also sometimes help. There are also some medications that can slow down the digestion process in the small intestine. This allows food to be in the small intestine for a longer time. 

Prevention measures vary based on the underlying cause of the condition. When diseases like cystic fibrosis or celiac are a factor, managing those diseases is an important way to prevent malabsorption issues. Additionally, since some antibiotics and laxatives can cause malabsorption, you should use them carefully. Follow your doctor’s instructions to manage and treat the condition and prevent it from becoming severe. 

Our experienced team at GHP has years of experience treating conditions including malabsorption. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Cirrhosis: What You Need to Know

Cirrhosis is a condition in which your liver is scarred and suffers permanent damage. Here’s what you need to know about the condition. 

Causes and Risk Factors

When the liver is damaged, it attempts to repair itself and scar tissue forms. Over time, this scar tissue builds up and makes it difficult for the liver to function. Cirrhosis is the term for late stage damage. Damage can be caused by various conditions and diseases. These include chronic alcohol abuse, syphilis, chronic viral hepatitis, some genetic disorders, and nonalcoholic fatty liver disease. 

Risk factors for cirrhosis include excessive alcohol consumption, having viral hepatitis, and being overweight. Each of these factors can lead to some of the diseases and conditions listed above, which can damage the liver and lead to cirrhosis over time. 

Symptoms of Cirrhosis

There are several potential symptoms of cirrhosis. In the early stages of disease, many people do not experience any symptoms. Symptoms and complications often occur in later stages of disease, when it is more severe. These include severely itchy skin, fatigue, nausea, loss of appetite, jaundice, easily bleeding and bruising, and fluid accumulation on the abdomen. 

Diagnosis

In cases of early-stage cirrhosis, most people do not have symptoms, and diagnosis is likely to be incidental through a routine blood test or doctor’s visit. In general, doctors diagnose cirrhosis through a combination of physical exams, blood tests, medical history, and symptoms. Often, doctors will order additional testing to confirm a diagnosis. They may do this through blood testing, imaging tests, or biopsy. Imaging tests and biopsies can help determine the extent of cirrhosis, and blood testing can help identify the underlying cause of the condition. For example, blood testing may help identify elevated bilirubin levels, creatinine levels, or hepatitis infection. 

Treating Cirrhosis

Treatment approaches for cirrhosis vary based on the extent and cause of liver damage. Typically, treatment will focus on preventing or treating any symptoms and slowing the rate of scar tissue buildup on the liver. If doctors catch cirrhosis early, the underlying cause may be treatable to reduce any further damage. For example, if someone has developed it as a result of chronic alcohol abuse, their doctor will likely recommend they quit drinking. They may be encouraged to join an alcohol addiction program if quitting is difficult.

If hepatitis causes cirrhosis, there are medications that can treat the virus to prevent further liver damage. If it develops due to nonalcoholic fatty liver disease, focusing on weight loss and controlling blood sugar can help. Additionally, there are often medications that can help treat symptoms and complications like pain, itching, and osteoporosis. In late-stage cases, when the liver has too much damage to function, a liver transplant may be the only option. 

Prevention

Preventing and managing cirrhosis entail several lifestyle behaviors. Avoiding alcohol, practicing safe sex, exercising regularly, eating a healthy diet, and using over the counter medicines carefully are good prevention measures. 

Our experienced team at GHP has years of experience treating conditions including cirrhosis. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

What is Jaundice?

Jaundice causes the whites of the eyes, skin, and mucous membranes to turn yellow as a result of heightened levels of bilirubin. Here’s what you need to know about the condition.  

Causes and Risk Factors

Jaundice is ultimately caused by bilirubin levels that are too high. Bilirubin is a yellow chemical in hemoglobin, the part of red blood cells that carries oxygen. The body builds new red blood cells when old ones break down, and the liver processes the old cells. When the liver is unable to process these old cells properly, bilirubin builds up in the blood and deposits in the skin. The yellow color of bilirubin is what causes the yellowing of skin in jaundice. 

Jaundice is relatively common in newborns- many babies develop it in their first week of life, and it often goes away without issue. In adults, jaundice can be a sign of various problems. These include liver diseases (like alcoholic liver disease, cirrhosis, and hepatitis), blood diseases, infections, blocked bile ducts, and viruses. 

Symptoms of Jaundice 

There are several symptoms of jaundice that people can experience at different levels of severity. Some people may not even have any symptoms. Ultimately, the symptoms a person experiences will depend upon underlying causes and the speed at which disease develops. In short-term cases, often caused by infections, symptoms typically include fever, abdominal pain, chills, flu-like symptoms, yellowed skin and eye whites, dark urine, and clay-colored stool. If a case is not caused by infection, symptoms can include weight loss and itchy skin. Abdominal pain is also common when pancreatic or bile duct cancers cause jaundice. 

Diagnosis

Jaundice is diagnosed through a few different steps. Doctors first perform physical exams to check for signs of liver disease. These signs include yellowing and bruising of the skin, spider angiomas (blood vessels that collect near the skin surface), and palmar erythema (red coloration in the fingertips and palms). They also perform urinalysis to check bilirubin levels in the urine, which can indicate jaundice. They often perform serum testing to confirm findings from urinalysis as well. Additionally, they may want to pursue imaging of the liver through an MRI, CT, or ultrasonography to further confirm any diagnosis. 

Treatment and Prevention for Jaundice

Treatment for jaundice entails treating the underlying causes and complications of the condition, as well as any symptoms. For instance, if acute viral hepatitis is a cause, it will go away as your liver heals.  Treatment may entail treating the hepatitis symptoms. Surgery can help unblock bile ducts in cases of blocked ducts. A drug called cholestyramine can be used to limit itching if itchy skin is a symptom. 

Preventing jaundice entails preventing the various underlying causes. This means that limiting alcohol intake, avoiding hepatitis infection, and maintaining a healthy weight and cholesterol levels can all reduce your risk. 

Our experienced team at GHP has years of experience treating conditions including jaundice. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Coronavirus and the GI system: What does the evidence tell us?

The coronavirus continues to have an enormous impact on the way we live. Over the past several months, we have begun to learn more and more about the virus. We’ve learned about how it spreads, its symptoms, how to detect it, and potential approaches for vaccines. Crucially, the virus has several documented impacts and features related to the gastrointestinal system. Let’s take a look at the evidence. 

Note: As the medical and public health understanding of the coronavirus continues to evolve, there’s a lot we still don’t know for certain. It’s important to recognize the difference between evidence-based conclusions, emerging evidence without sufficient peer review, and speculation. We will carefully frame each point based on the amount and kinds of evidence supporting it. 

Coronavirus Symptoms Associated with the Gastrointestinal System

The coronavirus can cause a range of symptoms, from a fever to a loss of smell and a headache. We do know that it can cause gastrointestinal symptoms in some cases. These well-documented GI symptoms include loss of appetite, nausea, vomiting, and diarrhea. However, not everyone with coronavirus will experience these symptoms. 

Some interesting emerging research suggests that there may be clusters of symptoms. One of these clusters involves gastrointestinal symptoms. Researchers at King’s College London studied data from around 1,600 COVID-19 patients who logged their symptoms to the research group’s COVID Symptom Study app in March and April. They found six distinct clusters of symptoms from the data: 

  1. Flu-like with no fever. Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
  2. Flu-like with fever. Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
  3. Gastrointestinal. Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
  4. Severe level one, fatigue. Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
  5. Severe level two, confusion. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
  6. Severe level three, abdominal and respiratory. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

As you can see, the gastrointestinal cluster includes GI symptoms like diarrhea and loss of appetite. Other clusters also contain GI symptoms. Each cluster was also associated with differing proportions of patients who required hospitalization and breathing support. The escalating severe clusters had the largest percentage of patients requiring significant medical support. 

It’s important to note that while the researchers have replicated their findings with a second 1,000 person data set from June, the research is not peer-reviewed yet. However, this is certainly something to keep an eye on as more data trends emerge. 

Sewage: A Potential Method for Measuring Infection Spread

Early on in the pandemic, evidence emerged from multiple studies showing that people infected with the coronavirus shed viral particles in their poop. Whether the disease can spread through feces is still undetermined. However, there has been growing interest in sampling sewage to determine the extent of disease spread. 

This has been particularly appealing because of the lack of adequate testing in many countries. This has led to a significant undercounting of actual infection numbers. A cross-sectional CDC study conducted across multiple states used serological testing on a convenience sample with people of all ages to identify how many had developed antibodies to the disease. This gave a more accurate picture of how many people have been infected, since the presence of antibodies indicates that a person had been or was currently infected. The study found that actual infection numbers were likely 10 to 12 times higher than reported through testing. Note that large-scale seroprevalence studies like this one are continuing to be conducted to identify likely infection rates, so the results here are preliminary. 

With such a disparity between reported and actual case counts, wastewater sampling offers a convenient and accessible way to identify disease spread in a particular area. Importantly, results are quicker than those from viral and serological tests. This is helpful, timely data that can inform decisions about disease containment in the event of a flare-up. Additionally, it can help researchers see the viral ancestry of the disease, tracking different strains, viral changes over time, and spreading patterns and paths. 

There are drawbacks, though. This kind of sampling can’t prove that an entire population is completely clear of the virus. Another drawback is that we still don’t know how many copies of viral RNA need to be present in a sample for disease to be detected. This means false negatives are possible, as we don’t know the minimum number of copies that trigger detection. A lower count of copies could go undetected with an improper assumption about a minimum. 

Overall, there’s certainly a lot we still have to learn about the coronavirus and the GI system. However, as scientists conduct more and more research, we have a better opportunity to make data-informed decisions at public health, medical, governmental, interpersonal, organizational, and individual levels. 

Our experienced team at GHP has years of experience helping patients with a variety of diseases and conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Retrograde Cholangiopancreatogram (ERCP): A Brief Overview

An Endoscopic Retrograde Cholangiopancreatogram (ERCP) is a therapeutic endoscopic procedure that helps diagnose and treat diseases in the liver, gallbladder, pancreas, and bile system. Here’s what you need to know about the procedure. 

When an ERCP is used

There are several reasons your doctor may perform an ERCP. One common reason is to diagnose and treat gallstones that are trapped in the bile duct. They may also perform an ERCP to identify the source of persistent upper right side abdominal pain, to identify a cause of pancreatitis, or to relieve bile duct obstruction caused by tumors. Often, doctors will inject a dye in the bile ducts during an ERCP to assist with X-ray imaging.

Preparing for an ERCP

There are a few important steps to prepare for an ERCP. You will need to discuss any medications you are taking with your doctor. Blood-thinning medications like Coumadin (warfarin), Eliquis (apixaban), Lovenox (enoxaparin), Plavix (clopidogrel), Pradaxa (dabigatran), and Xarelto (rivaroxaban) are especially important to discuss. These can increase the risk of severe bleeding during the procedure, and you should stop taking them before the ERCP. Also, if you use insulin, you may need to adjust timing or dosage on the day of the procedure. Your doctor will also need to know if you have any allergies to medications. Additionally, you will need to fast starting the midnight prior to your procedure. This means avoiding eating from that time until your procedure. 

During the Procedure

Prior to the ERCP procedure, you will go to a pre-op area where nurses will place an IV and take your medical information. You will also speak with an anesthesiologist about the sedation used during the procedure. 

Once you have moved to the procedure room, you will be connected to machines that monitor your vitals during the ERCP. You will be sedated during the procedure. Your doctor will feed the endoscope through your mouth and perform the procedure. The specific techniques and treatments they use will depend on your situation, and include opening blocked ducts and inserting stents. They may also take X-rays during the procedure. Contrast dye is injected through the endoscope to assist in developing X-ray imaging of your bile ducts. In total, the ERCP should take around 30-40 minutes. 

After the Procedure

After the ERCP, you will go to a post-op area to recover from sedation and the procedure and will be monitored for complications. Once you have recovered, your doctor will discuss the results with you, though any biopsies will take a few days to return. You should not operate machinery, drive, or make important decisions for 24 hours after your procedure due to sedative effects. 

It’s common to have a sore throat immediately after the procedure; throat lozenges can help treat soreness. You should follow a clear liquid diet after the ERCP, eventually transitioning to bland foods. 

The procedure has a few uncommon risks. Around 7% of patients experience pancreatitis, an inflamed pancreas. This requires hospitalization to rest the pancreas and manage inflammation. In very rare cases, this can be severe and lead to surgery, organ failure, or death. 

In very rare cases, perforation occurs during the procedure. Most of the time, this can be managed with hospitalization, bed rest, antibiotics, and bowel rest. Rarely, you may need surgery to repair the perforation. 

There is a low risk of bleeding as well, which occurs in around 0.5% of cases. When managed during the procedure, it can be stopped. Delayed bleeding requires patients to return to their doctor for treatment. 

Our experienced team at GHP has years of experience performing ERCPs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Endoscopic Ultrasound: How to Prepare

An Endoscopic Ultrasound (EUS) is a procedure for assessing and producing images of the digestive system with an endoscope. It is also used as a modality to treat certain gastrointestinal disorders through fine-needle aspiration (FNA). Follow along for an overview of EUS. 

When an Endoscopic Ultrasound is used

An EUS can help doctors determine the source of chest pain, abdominal discomfort, and other symptoms. It can also help them evaluate the extent of disease spread in your digestive tract, and evaluate findings from other diagnostics like MRIs or CT scans. It can help evaluate conditions including Barrett’s Esophagus, Lymphoma, and various cancers. 

There are many different therapeutic procedures that can be performed during an EUS. These include celiac plexus neurolysis (EUS-CPN), pseudocyst drainage, biliary drainage (EUS-BD) and liver biopsy. Each of these treatments has a unique set of steps involved. Below, we will take a look at some general steps and approaches involved with the various diagnostics and treatments performed through an Endoscopic Ultrasound. 

Preparing for an EUS

The way you need to prepare for an EUS depends on the specifics of the procedure and any therapeutic treatments in your case. In general, you often need to fast starting the midnight before the procedure. This helps empty your stomach. You may also need to discuss any medications you are taking with your doctor before the procedure. It is especially important to stop taking any blood-thinning medications leading up to the procedure. These medications can increase the risk of severe bleeding during the Endoscopic Ultrasound. If the EUS is being performed in the rectal area, you may need to undergo a cleansing routine to prepare your bowels. This usually consists of taking a liquid laxative and sticking to a liquid diet for a day before the procedure. 

During the procedure

On the day of your Endoscopic Ultrasound procedure, you will first go to a pre-op area where your medical information will be taken and you will be given an IV. You will also discuss sedation used during the procedure with an anaesthesiologist. 

Depending on the location in your GI tract that doctors will examine or treat, they will advance an endoscope through your mouth or a colonoscope through your anus. You will be on your left side and may be sedated as this happens. Your doctor will advance the scope to the site or sites of interest and then perform any diagnostics or treatments. This can include tissue biopsies, pain-relieving injections, pseudocyst drainage, and bile duct drainage, depending on your situation. Your doctor will be able to see your GI tract through a camera at the end of the scope, and will pass any necessary instruments through the scope to perform the procedure. Most EUS examinations take under an hour, but the exact time will vary depending on what diagnostics or treatments your doctor is administering. 

After an Endoscopic Ultrasound

After your procedure, you will go to a post-op area where you will recover from any sedation and be monitored for side effects of the procedure. Once you are recovered, your doctor will share results with you. Some biopsy results may take longer to return. Given sedation side effects, you should not operate machinery, drive, or make important decisions for 24 hours following the procedure. 

Endoscopic Ultrasounds have a relatively low risk for complications. If you underwent Celiac Plexus Neurolysis to provide pain relief for tumors, you may experience abdominal pain for a few hours and diarrhea for a few days. More rarely, bleeding, infection, and paralysis can occur. If you underwent Pseudocyst Drainage, there is a small risk of bleeding, infection, and pancreatitis. Additionally, in under one percent of cases, perforations occur, requiring surgery to repair. If you underwent Biliary Drainage, there is a 10-20% chance of mild complications associated with bile drainage. These include bleeding, infection, and bile leakage in the abdominal cavity. If you underwent a Liver Biopsy, complications are very rare, and include a small risk of bleeding and infection. In general, if you were sedated during your procedure, there are a few uncommon complications including aspiration, adverse reactions to sedative medication, and complications from lung and heart diseases. 

Our experienced team at GHP has years of experience performing Endoscopic Ultrasounds. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Mucosal Resection (EMR): An Overview

Endoscopic Mucosal Resection, or EMR, is a therapeutic technique that helps remove precancerous and early stage cancer lesions during an upper endoscopy or colonoscopy. This technique is a less-invasive alternative to surgery. Here’s what you need to know if you are preparing for an EMR.

When is an Endoscopic Mucosal Resection Used?

EMRs are used to remove abnormal tissues in the digestive tract. The procedure can help treat a variety of conditions including Barrett’s Esophagus, colorectal cancer, and colon polyps. This is a less invasive option than surgery for removing abnormal tissues in the digestive tract. While EMRs are often used to treat disease, your doctor may also collect tissue samples during the procedure. They can examine tissue they collect to determine a diagnosis and the scope of disease spread. 

Preparing for an EMR

There are several important steps you need to follow prior to an Endoscopic Mucosal Resection. Your physician will discuss each of these with you leading up to the procedure. First, you may need to stop taking certain medications. These include blood-thinning medications like aspirin, Plavix (clopidogrel), Xarelto (rivaroxaban), Lovenox (enoxaparin), Pradaxa (dabigatran), Coumadin (warfarin), and Eliquis (apixaban). Blood-thinners increase your risk of excessive bleeding during the procedure. Also, if you use insulin, you may need to adjust your dosage and timing before the procedure. Make sure you discuss all medications you use with your doctor. 

Additionally, you will need to follow a clear liquid diet the day before the procedure, and stay hydrated. You will also need to fast beginning the midnight before your procedure. For EMRs performed through a colonoscopy, you will also need to undergo a cleansing routine. This involves taking a liquid laxative the day before your EMR to prepare your bowels. 

During the procedure

EMRs are performed through either an upper endoscopy or a colonoscopy, depending on the location of the diseased tissue. When you arrive for your procedure, you will go to a pre-op area where nurses will take your medical information and place an IV. You will also speak with an anaesthesiologist about the sedation they will use for the procedure. 

You then will go to the procedure room and be connected to monitors that will measure your vitals during the EMR. You’ll be sedated at this point. If the procedure is done through an upper endoscopy, you will be placed on your left side and given a bite block so the endoscope can pass through your mouth safely. If it is done through a colonoscopy, you will also be placed on your left side so the colonoscope can pass through your anus and advanced into the colon. 

Your doctor will be identifying and removing lesions during the EMR. There are several ways to remove lesions. Your doctor may inject a liquid into the submucosal layer under the lesion, which acts as a pillow that lifts the lesion for easy removal. They may also use a suction or a rubber band to help lift the lesion. After the lesion is lifted, it will be captured with a snare and the removal site will be cauterized. The procedure takes around 20 to 60 minutes.  

After the Endoscopic Mucosal Resection

Following your EMR, you will move to a post-op area to recover from sedation and monitor for any complications. Once you have recovered, your doctor will talk to you about the findings and give you post-op recovery instructions. You should not drive or make important decisions for 24 hours following the EMR due to sedative effects. You should follow a clear liquid diet immediately following the procedure, and can later transition to bland foods and a more regular diet. 

Complications from an EMR are uncommon. This includes bleeding, which occurs in 5-10% of cases. Your doctor can usually stop bleeding during the procedure if they recognize it. However, bleeding can become severe if it is delayed and may require follow-up care. In other rare cases (1-2% of the time), perforation of the intestine can occur. This is often managed through antibiotics, bowel rest, and hospitalization. It may require surgery as well. Additionally, some patients have reactions to sedative medication in uncommon cases. Always contact your doctor if you have any severe symptoms like abdominal pain, a fever, or excessive rectal bleeding after the procedure, as they may indicate a severe complication. 

Our experienced team at GHP has years of experience performing EMRs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Hemorrhoid Banding: What to Expect

Hemorrhoids are swollen veins in the lower rectum or anus. They can cause bleeding, itching, and pain. While most hemorrhoids resolve with home treatment, some can be harder to get rid of. There are several non-invasive treatments for hemorrhoids. In cases of highly symptomatic hemorrhoids, banding is one approach that can help. Here’s what you need to know about hemorrhoid banding.

When Hemorrhoid Banding is used

As mentioned above, in cases of highly symptomatic hemorrhoids, hemorrhoid banding (sometimes called rubber band ligation) may be used. These symptoms include severe pain, severe bleeding, prolapsing (protrusion through the anus), and hemorrhoids with blood clots. Hemorrhoid banding is a non-invasive, non-surgical procedure that cuts off the hemorrhoid’s blood supply. Eventually, the hemorrhoid falls off as a loss of blood supply.

Before the Procedure

In the days leading up to the procedure, your doctor may ask you to stop taking certain medications. These include ibuprofen, aspirin, or any other drug that makes it difficult for blood to clot. Your doctor may also perform some diagnostics prior to the procedure to identify the hemorrhoid and its state. This may include a physical examination, a rectal examination, a sigmoidoscopy, or an anoscopy.

During the Hemorrhoid Banding Procedure

The entire hemorrhoid banding procedure only takes about five minutes. During the procedure, your doctor will place a tube-like instrument in your anus so they can examine the hemorrhoid. They will then put a tight rubber band around the base of the hemorrhoid. This cuts off the blood supply. You may experience some discomfort during the procedure.

After the procedure

After your doctor performs the hemorrhoid banding, your doctor will advise you regarding recovery and may schedule a checkup or another appointment. You may need multiple bandings to remove a hemorrhoid. Hemorrhoids may take around a week to fall off after a successful banding procedure.

In the days following your procedure, you may have some difficulty with controlling bowel movements and passing gas. Fortunately, there are a few things you can do at home to help with this. For one, make sure you move your bowels right when you feel the urge to do so. Do not sit on the toilet for long periods of time, and don’t strain during bowel movements. To avoid constipation and straining, eat lots of fiber, stay hydrated, and exercise. Additionally, you should avoid heavy lifting for two or three weeks.

While serious complications are rare with this procedure, there are a few signs to look out for after your hemorrhoid banding. These include any signs of infection (like fever or chills), passing a lot of blood, having uncontrollable pain, having trouble urinating, and developing an aching feeling between the rectum and genitals. Call your doctor if any of these symptoms develop.

Our experienced team at GHP has years of experience performing hemorrhoid banding. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Breath Testing

Breath testing is a noninvasive method doctors can use to diagnose gastrointestinal conditions. Here’s what you need to know about breath testing. 

Breath Testing 

Breath testing gives doctors a noninvasive way to diagnose several conditions. They can analyze your breath to detect amounts of particular gases, making diagnosis quick and simple. Typically, there are a few pre-testing steps you will need to follow, including consuming particular liquids and avoiding certain activities before or during breath testing. The specifics for each type of breath testing are discussed in the following sections. 

Bacterial Overgrowth Breath Test

This test is used to figure out if there is too much bacteria growth in the small intestine. This sort of overgrowth can prevent your body from absorbing nutrients properly. In the day prior to this test, you will need to limit your consumption of slow-digesting foods like beans and pasta. You will also need to fast for 12 hours before testing, and should not sleep, smoke, or exercise vigorously directly before or during the test. Additionally, you should avoid chewing gum, having mints, using mouthwash, or brushing your teeth the morning of. Stop using probiotics for the two weeks leading up to testing as well. You need to reschedule the testing if you have been taking antibiotics within 48 hours. Finally, you may consume water up until the time of testing, but you can’t eat or drink during the test. 

During Bacterial Overgrowth Breath testing, you will first breathe into a small machine. Then, you’ll consume a lactulose solution (this may cause abdominal pain or diarrhea for some people). 90 minutes later, you will breathe into the machine again. Last, you will wait an additional 30 minutes and breathe into the small machine. 

Fructose Breath Test

Fructose testing helps determine whether you may have trouble absorbing fructose. Symptoms like gas, bloating, diarrhea, and cramping can be a sign of fructose malabsorption. Fructose is a sugar that is in many plants you may consume, like onions, artichokes, and pears.

Preparation for this test is similar to the aforementioned testing. The day before the test, you need to limit consumption of slow-digesting foods. Stop taking medications leading up to the test. You must fast for 12 hours before testing, and shouldn’t smoke, sleep, or exercise vigorously right before or during testing. Also, you should not chew gum, use mouthwash, brush your teeth, or have mints the morning of testing. You may consume water up until the time of testing, but you can’t eat or drink during the test. Finally, you should let your doctor know if you have taken antibiotics recently or if you have been having diarrhea. 

Three hours prior to the testing, you will need to consume 12oz of Coca-Cola. When you arrive for the test, you will breathe into a machine that will measure for hydrogen gas. You will breathe into the machine in 30 minute intervals for three hours. 

Pylori Breath Test

H. Pylori breath testing helps doctors detect the presence of H. Pylori bacteria in your stomach or small intestine. This bacteria can cause diseases and increase your risk of gastric cancer. Two common conditions associated with the bacteria are gastritis and gastric ulcers. 

To prepare for H. Pylori breath testing, you should stop taking proton pump inhibitors like Prilosec OTC or Nexium. These can lead to false readings. You will also need to stop taking antibiotics two weeks before testing. Additionally, you should stop taking Sucralfate, Pepto-Bismol, and Carafate. Finally, you will need to fast for the hour leading up to the test. 

During testing, you will first give a breath sample. Then, you will drink a Pranactin-Citric solution and give another breath sample 15 minutes later. 

Lactose Breath Test

Lactose breath testing helps diagnose lactose intolerance. This intolerance prevents you from being able to digest lactose (a sugar found in milk) properly. Common symptoms of this intolerance are bloating, gas, cramping, and diarrhea after consuming dairy products. 

Preparation for this testing is similar to preparing for a Bacterial Overgrowth or Fructose test. The day before testing, you will need to limit consumption of slow-digesting foods like beans and pasta. You also need to fast for 12 hours before testing, and should not sleep, smoke, or exercise vigorously directly before or during the test. Additionally, you should avoid chewing gum, having mints, using mouthwash, or brushing your teeth the morning of. You will need to be off of any antibiotics for two weeks before testing. You may consume water up until the time of testing, but you can’t eat or drink during the test. Tell your doctor if you have had any recent diarrhea, as this can affect testing. 

Three hours before the test, you will need to consume 12oz of skim or fat-free milk. During the test, you will need to drink a beverage with lactose. This can cause intolerance symptoms. After this, every fifteen minutes, you will blow into inflatable bags that will be tested for hydrogen levels. An elevated hydrogen level means that lactose is not digested properly. 

Our experienced team at GHP has years of experience performing breath testing. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.