Kansas COVID-19 Update, Week 19

 

We're entering the bad times now. The days of overflowing hospitals and overburdened health care workers that first plagued Wuhan, then northern Italy and then New York City are now coming to Kansas, as unlikely as that once seemed. Wichita's ICUs are over capacity (231 patients as of Nov. 16, vs. a capacity of 208). Topeka's hospitals reached capacity last week and started boarding patients in hallways. They've now requested staffing help from the National Guard and FEMA. The Kansas City region still has some ICU capacity, but it's going fast, hovering between 10% and 20% availability most days. And it's harder to staff those beds because health care professionals are getting COVID too. 

All of which means delays in care and preventable deaths – for Kansans with COVID-19 and other conditions — for the foreseeable future. There are some signs that maybe new cases are finally leveling off in the KC area, but they're plateauing too high to be sustainable. And exponential growth in new cases continues in the western half of the state. The next few weeks are baked in, they will be bad regardless of what we do because the record new infections we are seeing will become record hospitalizations. But there are some reasons to be optimistic that we can shorten the really bad period, and make it less bad, if we do the right things.

The Good: The infection reproduction rate, or Rt, was 1.06 this week, down from 1.20 the week before. This is my glimmer of hope. To be clear, 1.06 is still too high. Anything above 1.0 means the number of active infections will continue to rise, and they're already at an unsustainable level. But COVID goes in waves, and the significant drop in Rt means we may be reaching the crest of this particular wave. I already noted that the pace of new infections is leveling off in the KC area. In Lawrence, it has actually begun to go down in the past week. That's what we need to see in the whole state. Both KC and Lawrence have mandated masks for months, and have occasionally taken other measures, like closing bars or limiting their hours. Some people think this is a coincidence. I obviously do not. Gov. Kelly issued a second mask mandate this week, but, like the first one, counties will be able to opt out of it, per the Legislature's orders. I hope that most won't. Based on this heat map, the part of the state that is now seeing the most new cases per capita is western Kansas, where most counties have no mask rules. 

The Bad: The test positivity rate in Kansas last week was 35.1%, according to Johns Hopkins. On it's face, that is a really bad number. But again, it's important to see it in the context of where we've been: It was 58.7% the week before. So although we're still confirming more cases, we're also testing more. Which means we aren't missing as many cases. Which is an important step in getting this thing under control. 

The Ugly: ICU capacity statewide fell to 30% this week, according to KDHE, including another record-high 279 COVID-19 patients in ICU (which means more than 1/4th of the state's total ICU beds are occupied by COVID patients). And it's actually worse than that. KDHE's data, in the spirit of good old government efficiency, is reported by hospitals to the feds, who then feed it into a computer program and send it back to the states. By the time it gets out to the public, conditions have changed. And it also includes pediatric ICU beds in children's hospitals. Fortunately, the Kansas Hospital Association is now publishing its own data directly. It shows that as of Friday only 16% of staffed adult ICU beds in Kansas were available (including one single bed in all of southwest Kansas). This is a major problem, given that our COVID wave is still peaking and flu season has barely begun. December is when influenza usually starts in earnest in Kansas. Which means that as bad as things are for hospitals now, they're about to get worse. November 2020 will go down in history as the month Kansas hospitals were pushed to the breaking point. Barring a miracle, December will go down as the month when they were pushed past it. 

Bonus: Let me start off this section by saying that Kansas House Speaker Ron Ryckman did read my open letter and called me to discuss it. He deserves credit for responding, and his response shows the power each of us have in state level politics. You can find your elected representatives, and their contact info, on this site: http://www.kslegislature.org/li/. I highly recommend you let them know how you're feeling.

I'm not going to get into the details of my conversation with Speaker Ryckman because he asked me not to. But I will summarize it by saying that although he believes in wearing masks, he doesn't think mandating them would work, because Kansans don't like the government telling them what to do. In a certain sense, I agree: another mandate from a Democratic governor, like Laura Kelly, probably is not going to move the needle much in parts of the state that are overwhelmingly Republican, because masks have unfortunately become a political litmus test. I still think that a mandate strongly and publicly supported by a bipartisan group that included Ryckman and other Republican leaders would increase mask wearing. I wish that would happen. But it doesn't look likely, and even if it happened today, our hospitals would still be in trouble for the next couple weeks. So what's a family to do? 

My suggestion: hunker down. Limit the time you spend out of the house and avoid interactions with anyone who doesn't live in your house. That means:

• Work from home if you possibly can. Tell your employer it's what the CDC recommends. If your job doesn't allow you to work from home, I'm sorry. The rest of us should do our best to make it safer for you to work. 
• Don't travel: I know, I miss my family too, and I want to be with them on Thanksgiving. But it's not worth killing Grandma. Even if you're not concerned about COVID (for instance, if you've already had it and now have antibodies), there are large stretches of Kansas where, if you get in a serious car wreck now, you may not be able to get the care you need promptly.
• If you see friends, do it outdoors, at a safe distance. I know it's cold. Wear a coat. 
• Get groceries and other necessities delivered, or pick them up curbside.
• Support local restaurants with takeout or delivery (and leave big tips). Don't risk eating inside.
• Work out at home, but continue paying your gym dues, if you can, to support the employees. 
• Don't go to the bar (Congress should get off its collective ass and pay these businesses to stay closed in high-COVID areas, which is frankly most of the country now). 
• Manage your chronic conditions: Some hospitalizations are unavoidable (heart attacks, stroke, etc). But it's in your best interest now more than ever to stay out of the hospital if you can. Take your medications, exercise, eat right, get enough sleep, and stay in touch with your primary care doctor via phone, email or telemedicine.
• Get a flu shot: You should have already gotten one, but it's not too late. If you're not comfortable going to a doctor's office right now, get it at a pharmacy. 
• Buy a pulse oximeter: If you get COVID, you will be told to stay home, isolate and try to fight it off unless your condition worsens to the point where you absolutely need to go the hospital. This device, which clips on your finger and retails for about $20, will tell you if you've reached that point. It measures your blood oxygen level, and a general rule of thumb is that if that goes down to 90% or below, you should go to the hospital.

That's the best advice I have. Like I said, we're in the bad times now. As Pres. Lincoln once said, "This too shall pass." If we all do the right things, diligently and consistently, it will pass more quickly.