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The hepatitis A epidemic in Kentucky is the worst in the country. Nearly 4,000 people were affected and another 40 killed 40 in February 2019.
Nikki Boliaux and Michael Clevenger and Chris Kenning, Louisville Courier Journal
Kathy Sanders was worried about the risk of losing her job last summer, when she told senior government officials that Kentucky's reaction to the hepatitis A epidemic that was raging was "too much" Little, too late. "
But the state's hepatitis coordinator decided that she was willing to take that risk because too many people were getting sick and dying of the highly infectious virus.
In e-mails and meetings last summer, Sanders issued a warning to the Secretary of the Cabinet of Health and Family Services, the General Counsel of the Cabinet and the Office of the Governor: the state must demonstrate more dynamism to cope with the outbreak.
She also explained her concerns about the new Public Health Commissioner, Dr. Jeffrey Howard, stating that he lacked experience in dealing with the crisis. She also explained how he rejected the recommendations of a former head of infectious diseases, who advocated an aggressive vaccination response of $ 10 million as liver disease began to invade the Appalachians.
However, state officials took no action to address Sanders' concerns as the virus spread into the mountains of eastern Kentucky, causing a major explosion in the country. It eventually spread to 103 of 120 counties in the state, with 43 dead and 4,229 sick.
Read more: Who is the nurse who denounced the response to hepatitis A in Kentucky?
Sanders is irritated by the lack of action by the state in the face of his warnings.
"These are people's lives," Sanders told the Courier Journal, after resigning as coordinator of the adult viral hepatitis prevention and control program on Feb. 22. "This hepatitis A. It's ugly.It's dirty.But somebody needs to focus on it and manage it."
"The heads must be turning, the members of the Commonwealth must be outraged."
Our investigation: Kentucky's "too low and too slow" response to the country's worst hepatitis A epidemic
"How many people will die?
The Courier Journal is investigating the state's response to the Appalachian epidemic that began last spring and is widespread among drug addicts and the homeless, who are particularly vulnerable to serious illness.
According to an article published on February 21, Dr. Robert Brawley, former head of the Division of Infectious Diseases of the State Department of Health, had recommended in May 2018 an aggressive response to combat the epidemic, including $ 6 million for vaccines and $ 4 million for temporary workers local health services.
He also called for a public health emergency declaration to help pave the way for federal help.
Instead, Howard, acting commissioner of the then Department of Public Health, sent $ 2.2 million in public funds to local health departments. He also refused to declare an emergency.
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Sanders struggled to know if she should speak.
"But you have to talk about it because what happened is not correct, how many people are going to die?" she says. "It was not taken seriously."
Gov. Matt Bevin's office officials have not responded to a request from the Courier Journal to comment on this story.
Adam Meier, Secretary of the Cabinet of Health and Family Services, said in a statement on Thursday: "We met with Ms. Sanders, reviewed and reviewed her claims, and concluded that her claims were unfounded and not credible – all as the justice of the peace's recent coverage of the state's response to the hepatitis A epidemic. "
Sanders said his concerns were believable because "what I told them already happened … … Result: 43 people died, more than 100 cases a week." It's not a question of who has Right or wrong, you have to do it right Know the mistakes Put on your big boy pants and train a team of experts with epidemic experience to get your hands on this case right now. "
Simon Haeder, assistant professor of political science at West Virginia University, said public health officials and politicians could learn from listening to workers further down the chain.
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"We need stronger protection of whistleblowers for people working in government," he said. "Obviously, Sanders' own department did not listen, his own administration did not listen. It must have been incredibly frustrating. "
The last: Kentucky Health Officials Criticize Courier Journal's Hepatitis A Survey but Support Review of an Organism
Emails describe Sanders concerns
Sanders, 55, worked for seven years at Brawley in the Infectious Diseases Division of the Department of Health. She worked closely with him and was primarily involved in hepatitis C, but she gave advice and participated in meetings on hepatitis A and drafted a federal grant that eventually funded a hepatitis A vaccine. worth $ 70,000.
Sanders wrote a shared hepatitis newsletter with 4,000 people, including people from US Centers for Disease Control and Prevention. She volunteers with the Kentucky Rural Health Association as the head of the hepatitis control team and talked about the disease across the country.
Last year, the CDC contacted Sanders and Brawley about their work on hepatitis B and C. They were also invited by the National Liver Alliance to participate in a multi-state collaboration in West Virginia.
Yet, despite his references, when Sanders expressed his concerns to senior officials of the state of Kentucky, these ignored his warnings.
Sanders sent an email to Meier on July 1, with a subject line worded as follows: "KY DPH – A story of too little, too late." Meier had been in this position for less than two months and was the third person to hold this position during the outbreak reported in November 2017.
In the email, Sanders told Meier that she was "taking a big risk in writing this letter because you might decide to fire me from my current position".
She mentioned in the e-mail that she had voted for Bevin and was "thrilled to see a new administration enter", but that she had been shocked by Howard's appointment as she had declared that "no one was here." he lacked experience in public health and as a doctor.
Hal Rogers: "A serious alarm alert has not been heard" during the Hepatitis A outbreak in Kentucky
Howard, 31, received his medical license from Kentucky in June 2018.
Brawley, 72, has been a doctor since 1975 and has degrees in epidemiology and infection prevention. He resigned in June and Sanders said in the email that he was "out of the blooming building".
A letter obtained by The Courier Journal indicates that on June 4, 2018, Brawley had been told that his services were no longer needed and that the action was taken without cause.
Brawley had the opportunity to resign and his letter of resignation indicated that he was "extremely proud of my 12 years of service …". Brawley confirmed in an interview that he was escorted out of the building.
Before Brawley left, Sanders wrote to Meier in his e-mail on July 1 st. He shared information from his past experiences with outbreaks and explained how San Diego County and Michigan controlled similar outbreaks.
She outlined Brawley's proposed response, which would have given 10 counties enough money to buy 10,000 doses of vaccine.
Instead, Howard sent money for 1,000 doses to each of the 10 counties at the end of May. This was the first time we cashed more than $ 2 million in agency funding sent to 48 counties and development districts.
Brawley's recommendations have been ignored, Sanders said in his email:
"KY DPH's infectious disease expert, the most experienced in public health, was evacuated from the building. Dangerous. Irresponsible. Too little … too late. "
Sanders sent the same email on July 17 to Dustin Isaacs, who at the time was an administrative liaison at the Constituency Office of Bevin. Sanders had already met and followed with the email, but stated that she had not received a response.
"Things go as usual"
By August 2018, Sanders was still not going anywhere, she said, and she was willing to reach out to anyone who could listen to her. She met with Johann Herklotz, General Counsel of the firm, in early August.
And on August 7, she sent Brawley an e-mail in which she recounted her memories of the outbreak response during her tenure, outlined all her recommendations, and indicated that Howard knew about it.
Herklotz replied, thanking Sanders for the information. He said that it would take time to review.
In September she met Herklotz and another lawyer. They said Howard was qualified, she recalls. She strongly disagreed.
"If anyone in this building, if any one in this country, knew how to deal with an outbreak, it would be (Brawley) .Nobody else in this building has ever faced with an epidemic of this magnitude, "she said.
She insisted that there are professionals in the department who do everything they can, but that they do not have the necessary support from the leaders.
If the state reacted aggressively to its concerns, "we could consider a situation different from what we are currently experiencing," she said. Instead, "business is going as usual, and we have a spread of hepatitis A that is affecting all of Kentucky in all the counties, then in the neighboring states."
Read more: Legislator states that it is necessary to examine Kentucky's "bad answer" to the deadly hepatitis A epidemic
"Put the boots on the ground"
Howard, who became commissioner in June, defended his decision regarding state spending.
He added that the state had used the limited funds it had to increase the number of vaccines that can be administered by small staff in county health departments. He also stated that he was willing to request more funding from the state if needed.
State officials said their strategy was based on best practices – sensitizing and vaccinating drug users and homeless people in places such as needle and syringe programs and treatment centers.
Howard said he had taken into account the fact that rural counties had other ways to get a vaccine in addition to special state funds, such as ordering a vaccine funded by the federal government to the state or buy vaccines containing nearly $ 233 million in county health department reserves.
Howard also wrote a letter to lawmakers challenging the Courier Journal's investigation, claiming that it led readers to draw false conclusions.
He added that the articles show that the Courier Journal does not understand Kentucky's public health system, in which state health departments and local health departments share governance. In most cases, his department "generally can not require or force a locality to continue its action".
Opinion: Kentucky must investigate its dismal response to the deadly outbreak of hepatitis A
Meier emphasized that the response, led by the state epidemiologist, was guided by a public health team composed of epidemiologists, doctors, doctors, and medical officers. nurses and scientists. He pointed to the County Health Department's reserves and other sources of funding available to help fight the epidemic.
Meier said that he supported Howard's decisions, adding that "the challenges facing Kentucky were of a less financial and logistical nature as it was about identifying and to mobilize populations at risk ".
Haeder, the West Virginia professor, said that money plays an important role in logistics because it takes resources to pay extra nurses in public health in rural areas. These nurses could not only help vaccinate against hepatitis A, but also identify other potentially dangerous diseases, or help people get treatment.
They could help treat diseases much more expensive to treat than to prevent.
Brawley told the Courier Journal that, considering all the people Sanders had contacted, "it is difficult to understand why no further action has been taken".
In a previous interview, however, Howard said that even after Brawley left, the department had experienced staff and expertise to deal with the crisis.
"We have never been deliberately meager during this epidemic," he said.
On Friday, Kentucky public health officials held a press conference in Frankfurt to firmly defend Howard's decisions and criticize the Courier Journal's investigation.
Chris Crum, Director of Public Health, Greenup County Department of Health, wrote a letter of support to Howard at the Friday press conference:
"Without the Commissioner's support, the necessary resources would not have been allocated to the Greenup County Health Department as soon as possible and the repercussions could have been much more devastating."
The press conference was held the same day that Sen. Morgan McGarvey, MP for Louisville, tabled a resolution directing the state agency to reconsider its response to the outbreak, saying it wanted to understand all the factors at stake and know what could be improved.
"We need to find out what happened, why, and what will not happen," McGarvey said. "I did not come here today to criticize the media. I would not be aware of this problem if it was not to report it and put it on the front page of the newspaper. "
Sanders said she would like to see Kentucky respond to the epidemic in the Appalachians more like San Diego County, which has spent more than $ 12 million for its response. This included almost quadrupling vaccines given seven months after the start of the epidemic.
She said Kentucky should take similar measures.
"Put the boots on the ground now, San Diego, they were aggressive," she said. "They stormed the street, they got involved, they got their lawmakers involved, they got money, and that did not happen in California." They had the answer. that we had, it's hard to say how many millions … would be infected …
"Kentucky must be aggressive."
Related: Hepatitis A made a deadly wave in the United States. This is how states fight against it.
Laura Ungar: 502-582-7190; [email protected]; Twitter: @laura_ungar; Support strong local journalism by registering today: courier-journal.com/laurau. Journalist Chris Kenning contributed to this story.
Read or share this story: https://www.courier-journal.com/story/news/2019/03/01/hepatitis-outbreak-nurse-told-kentucky-officials-response-too-late/3015982002/
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