Kansas COVID-19 Update, Week 41

COVID-19 cases are rising again in Kansas. But they still seem to be rising relatively slowly, and we're starting from a pretty low level. Our hospital capacity is solid and we're now up to about 28% of residents fully vaccinated and 41% with at least one dose. Within a month we should have enough vaccinated people to slow any outbreaks and if there's a surge in hospitalizations between now and then, I think we will have the beds to handle it. It's increasingly looking like COVID no longer poses an acute threat to Kansas' health care system (although I reserve the right to change my mind if a vaccine-resistant variant emerges). Soon we will be able to gather again at work, at school and in stadiums without worrying about our hospitals being overrun a few weeks later. But vaccine hesitancy could still cause hundreds of unnecessary COVID deaths in the state every year for the foreseeable future (more on that below).

The Good: Hospital ICU capacity remained at 30% this week, according to the Kansas Hospital Association. In fact, the number of people hospitalized for COVID in the state actually fell from 263 to 261 — the first decrease in several weeks. If there is one region where ICU capacity is still a tad worrisome, though, it's (you guessed it) south-central Kansas, which was down to 17% this week. 

The Bad: The estimated infection reproduction rate, or Rt, stayed at 1.1. Of course it's good that it didn't go up, but as long as it remains above 1.0, the number of active infections in our state will continue to rise. 

The Ugly: Test positivity in Kansas was 11.3% this week, according to Johns Hopkins. That's actually a slight improvement over last week (11.7%), but it's frustrating that this number continues to be so high. Kansas had the fifth-worst positivity rate this week, behind Idaho, Iowa, Alabama and Michigan. In California and Vermont, the rate was 1.1%, according to Hopkins. They're doing a lot of testing. 

Bonus: This week, Wisconsin senator Ron Johnson seemed to poo-poo the importance of reaching herd immunity against COVID, saying of vaccines: "What do you care if your neighbor has one or not?" Well, here's a story from this week that illustrates why we should all care: An unvaccinated staff member brought COVID into a Wichita nursing home, where five residents were infected despite being vaccinated. This should not be surprising. Remember, even the most effective COVID vaccines on the market only work about 95% of the time. So if you have a nursing home with 100 fully vaccinated residents (which is not an unusually high amount), and someone brought COVID in, you would expect five residents to get infected. In fact, you would probably expect more than that, since nursing home residents are generally elderly and/or frail and therefore less likely to mount a robust immune response due to vaccination than the general public. 

Fortunately all the infected residents of the Wichita facility are asymptomatic, at least as of this week (that's another great reason to get vaccinated — studies show that even if you get infected, the shot makes you less likely to get sick). Nursing homes in other states have not been quite as fortunate, with some vaccinated residents dying. This is why herd immunity is important, and why we should all care about whether our neighbors and others we interact with regularly are vaccinated. Because otherwise they will continue to be vectors for disease. It's becoming increasingly clear as we collect data that the vaccines make you much less likely to transmit COVID to others. Vaccination is therefore a numbers game: the more people in a given area who are vaccinated, the harder it is for the virus to find a viable host. If we squeeze off enough pathways to viable hosts, the virus dies without being able to replicate. That's how we reach herd immunity, when even the people who can't be vaccinated for medical reasons are fully protected from the illness because the virus has been choked off completely — like we did with polio and measles (at least until recently). If we don't get there, we will continue to see COVID deaths forever, which would be a damn shame, considering how preventable they are now. 

When you get vaccinated you're not just helping yourself, you're helping everyone you come into contact with. When you decline vaccination, you're not just putting yourself at greater risk, you're putting everyone you come into contact with at greater risk. It's your right to choose whether you want to get the vaccine or not. But personal liberty with no sense of civic responsibility is just selfishness. 

Kansas COVID-19 Update, Week 40

We're entering a new phase now. It looks like cases may be increasing in Kansas, which is not unusual right now. They're rising in 38 states. The increase is slow at this point, and the overall case level is relatively low (roughly comparable to June 2020 levels). But we've seen in Michigan that cases can still accelerate quickly. The key, of course, is vaccinations. We're at a solid 36% or so of the Kansas population with at least one dose and making solid progress. In a month we could be approaching herd immunity. But we're not there yet.

The Good: Hospital ICU capacity rose from 29% to 30%, according to the Kansas Hospital Association. Overall COVID hospitalizations in Kansas rose from 252 to 265, but that's a little slower rate of increase than last week, and every region of the state has at least 23% capacity right now. So we have some cushion if there's another surge.

The Bad: Test positivity fell, but only from 11.8% to 11.7%, according to Johns Hopkins. We would love to see a bigger decrease than that in order to give us more confidence in our case numbers. Kansas' positivity rate is 7th-worst in the country, behind Idaho, Iowa, Michigan, Alabama, Mississippi and South Dakota. 

The Ugly: The infection reproduction rate rose from 0.93 to 1.1. That's a significant jump, and we've passed the key 1.0 threshold, which is when we go from decreasing cases to increasing cases. Our state's lack of testing makes this number hard to pin down, week to week. Last week's number may have been a little artificially low.  

Kansas COVID-19 Update, Week 39

Another week, another win. New cases are still declining in Kansas (albeit slowly) and are at roughly the same level as last June. Meanwhile, about one out of every three Kansans has now had at least one vaccine dose. We seem to be winning the race against the variants so far, but the states around us aren't doing as well. The number of new cases is growing again in Nebraska, Colorado and Oklahoma (it's basically flat in Missouri). The virus doesn't respect state lines, so it's fair to assume that some of those new cases may seed more cases here as well. 

The Good: The infection reproduction rate fell from 0.94 to 0.93 in Kansas this week. That's not much change, obviously (and may reflect nothing more than less testing). But we're at the point where every week this metric stays about the same it's a win. 

The Neutral: Hospital ICU capacity rose from 28% to 29%, according to the Kansas Hospital Association. That's a little better, and the lowest region within the state (south-central Kansas) is now up to 19%. But in taking a deeper look at the data there's some reason for concern. The number of COVID-19 patients hospitalized (in any bed, regular or ICU) had been dropping every week since January. Until this week. This week it rose from 230 to 252. That's still way lower than our peak (when we had about 1,600 COVID patients in Kansas hospitals), and only 43 of those 252 patients are in ICU, so far. But it's still something to keep an eye on.   

The Bad: Test positivity rose from 11.4% to 11.8%, according to Johns Hopkins. That's fifth-worst in the country, behind only Idaho, Iowa, Michigan and South Dakota. It's not a huge change from last week, but I feel like a broken record noting every week what a poor job Kansas is doing on testing. Kansas City area health officials said last week that not enough people are getting tested, even if they have symptoms. It would be great to see that change, but at this point I'm not sure what would make people voluntarily become more diligent about getting tested. 

Kansas COVID-19 Update, Week 38

 

We're still looking good in Kansas. Nothing "ugly" this week, but there are reasons for watchfulness. Cases are still decreasing here, but the decrease is slowing (and cases now appear to be increasing in several states near us, which will have spillover effects). 

Michigan is fast becoming a cautionary tale about letting our guard down too early. Hospital ICUs are filling again in places like Detroit and Flint after COVID hospitalizations statewide doubled in March, driven mainly by variants infecting people in their 50s. Like other states, Michigan has now successfully vaccinated most of its seniors. But remember, according to the Mayo Clinic study cited in Week 35, almost 20% of people age 50-64 who get the coronavirus require hospitalization. That is very high compared to illnesses like the flu, and it means that hospitals can still fill up fast if thousands of people in that age demographic (which is largely still waiting on immunization) get infected in a short period of time. So for now, the prescriptions remain the same: wear a snug-fitting mask, maintain some distance from other people if at all possible, wash your hands, etc. At least until two weeks after your second shot. 

The Good: Test positivity dropped from 15.5% to 11.4% this week in Kansas, according to Johns Hopkins. That's almost exactly where it was two weeks ago, which makes me wonder if last week's spike was some sort of fluke or data reporting issue. Either way, it's good news. But Kansas is still sixth-highest in this metric nationally (behind Idaho, Iowa, Michigan, Alabama and South Dakota).

The Neutral: Hospital ICU capacity stayed the same, at 28%, according to the Kansas Hospital Association. It is now 16% in the south-central (i.e., Wichita) region, which is a little concerning, especially with new variants continuing to show up in Kansas. But every week that ICU capacity stays the same statewide is a win for us right now because it gives us more time to get vaccines in arms. About 30% of all Kansans (including yours truly) have now gotten at least one shot, and there's mounting evidence that even one shot significantly reduces your risk of carrying or transmitting the virus. States like Michigan that are experiencing rapid surges of cases would probably be well-advised to focus their vaccine doses on first shots right now, as England has done, even if it means delaying second doses for the time being. 

The Bad: The infection reproduction rate rose again, from 0.92 to 0.94. It's not time to panic, but the trend here is bad. This is two weeks in a row that this number has gone up, and we're creeping awfully close to that 1.0 threshold of where total case numbers will start to increase again. 

Bonus: Masks are in the news again in Kansas, as the Republican-led legislature has decided to overturn the Democratic governor's attempt to get everyone to wear them in public places. Someone asked me on Twitter recently how long states should really be expected to keep public health measures like mask mandates in place, now that vaccines are rolling out. I personally think there are two scenarios that should make us comfortable lifting the mask rules: 1. We reach herd immunity via vaccines (experts believe this will require about 75-80% of the population to be immunized), or 2. We drive case numbers so low that public health officials can identify the sources of all (or nearly all) infections, isolate positive cases and quarantine their contacts. This is what we already do with other contagious illnesses, like measles. We halt infection chains and keep epidemics localized. Unfortunately with COVID, our case numbers quickly overwhelmed our ability to do that last year, and we've never really gotten them low enough to do it since then. That has kept us in a state of "community spread," which is when public health officials can't identify the source of infections and instead have to advise us to treat everyone we come into contact with as a potential source. When you have community spread of COVID, requiring masks in indoor public places remains the easiest, lowest-cost way to reduce infections. There's evidence that after the initial wave last year (when masks were not really in wide use anywhere in the U.S.), the states that adopted mask rules generally suppressed the spread of the virus better than the states that didn't. So if it were up to me, I would stick with the mask mandates until we no longer have community spread, our we've reached herd immunity, whichever comes first.