Western Kentucky hospital officials and health care professionals are correcting misconceptions and answering questions about the COVID-19 vaccines, how hospitals track the vaccination status of those hospitalized with the virus, and the accuracy of COVID-19 tests as the Delta variant of the virus increasingly strains hospital capacity.
Kentucky Gov. Andy Beshear earlier this week called the pandemic “dire,” with the state repeatedly breaking records for the number of Kentuckians hospitalized with COVID-19, most of them unvaccinated.
On Thursday, Beshear said there were only 90 intensive care unit beds available in the entire state, the lowest number available since the beginning of the pandemic. More than 300 Kentucky National Guard members will be sent to 21 hospitals across the state to assist overworked health care workers, bringing the total number of hospitals being assisted by the national guard to 25.
The Kentucky Department for Public Health reported 3,339 confirmed new COVID-19 cases and 2,479 hospitalizations on Thursday. Kentucky’s COVID-19 positivity rate was 14.04% that day, from 14.16% on Wednesday.
The Pfizer, Moderna and Johnson & Johnson COVID-19 vaccines, which are highly effective at preventing hospitalizations and death, have been widely available throughout western Kentucky.
In late August, the Pfizer vaccine received full approval from the Food and Drug Administration (FDA) for use against COVID-19 for individuals 16 years of age and older. The vaccine had been authorized for emergency use since December 2020. When it was fully approved, the acting FDA commissioner in a statement said the full FDA approval could “instill additional confidence” for some to get the vaccine.
According to experts with John Hopkins Medicine, the FDA grants full approval to a vaccine when enough data demonstrates it is safe and effective for most people who receive it. The FDA has reviewed and approved the manufacturing process and facilities behind the vaccine. More than 165 million people have received one of the three COVID-19 vaccines to date.
But in western Kentucky, some people are still weary of the Pfizer vaccine. Violet Hannosh, a 28-year-old who is unvaccianted, said she said the FDA’s approval hasn’t assuaged her concerns about the vaccine because “it was going to get approved regardless.”
“It was already emergency approved, already trying to get it for younger and younger people,” Hannosh said at the Kroger grocery store in Murray. “People are getting booster shots.”
Jacob Cantrell, an 19-year-old Murray State University student who is unvaccinated, said he feels like the Pfizer vaccine is still “experimental,” suggesting there haven’t been animal trials and that the vaccine induces worse side effects compared to contracting COVID-19.
The Pfizer vaccine was tested on mice and non-human primates as early as September 2020, finding it protected animals from the virus. The Moderna vaccine and the Johnson & Johnson vaccine were also tested on animals, and are both authorized for emergency use by the FDA.
The chance of developing myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the lining outside the heart) after receiving the Moderna vaccine is very low, as is the chance of developing Guillain Barré syndrome (a neurological disorder in which the body’s immune system damages nerve cells) or blood clots from the Johnson & Johnson vaccine.
The FDA also provides fact sheets detailing possible side effects for both the Moderna and Johnson & Johnson vaccines. All three vaccinations have a growing body of evidence showing they prevent severe complications from the virus.
According to state data, only about 44% of Calloway County residents are fully vaccinated. Some western Kentucky counties have consistently had some of the lowest vaccination rates in the state.
Professionals and representatives from three western Kentucky hospitals provided commentary on questions and misconceptions raised by those unsure of the vaccines.
How Do Hospitals Track The Vaccination Status Of COVID-19 Patients?
Many western Kentucky hospitals publicly release the percentage of COVID-19 inpatients who are vaccinated. The way hospitals determine whether a COVID-19 patient is vaccinated varies, but most take the patient’s word for it.
Corie Martin, a spokesperson for Med Center Health in Bowling Green, said local health departments typically keep a database of anyone who has been vaccinated, which is then sent to the state. Med Center Health references this database when determining vaccination status.
As of Thursday, 70% percent of COVID-19 patients at Med Center Health are unvaccinated. Furthermore, 87% of intensive care unit patients and 80% of those on ventilators are unvaccinated.
Nanette Bentley, a spokesperson for Mercy Health in Paducah, and Jeffrey Eye, vice president of patient care services at Murray-Calloway County Hospital (MCCH), said their respective hospitals ask patients their vaccination status in the absence of a vaccine card.
“From a prognosis standpoint, it usually helps to know if this person is likely to do well or if this person is likely to not do so well,” Eye said of vaccination status. “Most of that information that’s being put out there is being done by hospitals to educate the public. It’s not reported to the government.”
Fully vaccinated patients are those who have had one dose of the Johnson & Johnson vaccine, or two doses of the Pfizer or Moderna vaccines. Eye said there has been some confusion among partially vaccinated patients who are reported in his hospital as unvaccinated, given that there isn’t a clear third category for partially vaccinated patients.
“[Some area hospitals] don’t go through all the time and effort to subdivide those out into three categories, partially because it just adds more noise to the conversation,” Eye said. “What is true is about 90% of all our hospitalizations are unvaccinated. We occasionally get one that’s partially vaccinated, and we would put them in the ‘not fully vaccinated’ category.”
How Common Are False Positives Or False Negatives?
Both Hannosh and Cantrell in Murray expressed concerns regarding the volume of false positive and false negative COVID-19 test results, with Hannosh questioning the validity of contact tracing in particular.
“I feel like, when they do the tracing, a lot of that stuff gets messed up because people are not being totally honest,” Hannosh said. “I feel like a lot of the contact tracing they do, you can’t get an accurate measure.”
A false positive result indicates the presence of the virus where it is not, whereas a false negative indicates the absence of the virus where it is. Eye with MCCH said false positives and false negatives are not common, especially when tests are conducted by healthcare professionals who can communicate the information to clinicians.
“A test is just a tool,” Eye said. “You need a clinician behind it to interpret the results.”
The two main types of COVID-19 tests are polymerase chain reaction (PCR) tests and rapid antigen tests. A National Institutes of Health study in June found PCR tests are more sensitive, especially during the early stages of infection, but both types had a sensitivity of 98% when performed regularly.
MCCH follows up every rapid test with a PCR to screen for false positives and false negatives. Last week, after running a report on the last thousand tests, MCCH found only 2% of rapid test results conflicted with that of their subsequent PCR tests, which Eye said lined up with the manufacturers’ specifications.
“[False positives and false negatives] range based on the test — all the manufacturers’ tests are different — but you’re talking single-digit percentages,” Eye said. “The rapid tests are most useful in a person that has symptoms, and the disease burden in the community is high.”
Eye said most false positives are clinically irrelevant, but a false negative can be worrisome from a public health standpoint.
“You said the patient didn’t have it [with a false negative], so they carry on with their everyday lives, but they’re actually contagious,” Eye said. “If you test positive and you feel fine and you have to stay home, the inconvenience factor is there — your disruption of life is there — but it’s not endangering anybody.”
Do Hospitals Make Money Off COVID-19 Patients?
Cantrell also questioned the financial incentives behind COVID-19 data reporting, claiming hospitals get a “bonus” for falsely stating patients have COVID-19.
Eye with MCCH said this misconception may have arisen because insurers reimburse a greater amount to hospitals for COVID-19 compared to less costly respiratory illnesses like pneumonia.
“[COVID-19] puts a giant strain on the staff and the resources, so whether or not we actually end up coming out ahead from a financial perspective, I could not answer that question for you,” Eye said. “But I would just assume not, because it is difficult to care for them. It’s hard on the staff. It’s hard on our throughput. It’s just difficult.”
Eye said the only financial incentive hospitals have is to report data to the government, because hospitals could be terminated from Medicare, Medicaid or any other federal payment system for not doing so. This data includes the number of tests performed, how many tests were positive and negative, how many patients were admitted, how many died, staffing levels, bed and ventilator availability and more.
He said the amount of expense COVID-19 patients accumulate accounts for much of the extra reimbursement hospitals receive for taking care of them.
“The only place it does actually make a difference is the patients who are admitted to the hospital, and they do pay a higher rate because they’re just that much more expensive to take care of,” Eye said.
Early in the pandemic, insurers reimbursed similar amounts to hospitals for COVID-19 patients as they would for other respiratory illnesses, Eye said. As insurers saw the cost reports for COVID-19 patients — which noted longer hospital stays and more expensive medication — they adjusted the reimbursement accordingly.
Hospitals were also paid CARES Act money to cover the increased costs of caring for COVID-19 patients, but Eye said the government will eventually reclaim any unused dollars.
