Kansas COVID-19 Update, Week 78

 

Things are still pretty dire, but there are signs that the awful wave we're in may have finally peaked, especially in the KC area. New cases are coming down from the crazy highs of a week or two ago, and COVID hospitalizations also are flat this week compared to last week (though still extremely high — at or near the highest they've ever been). 

The Good: Test positivity fell from 43.4% to 36.8% this week, according to Johns Hopkins. That's still quite high, and sixth-worst in the country (behind Alaska, New Jersey, Utah, Tennessee and Alabama). But it's a definite step in the right direction.

The Bad: The infection reproduction rate, Rt, remains at 1.1. That would mean that cases are still increasing, albeit slowly. There is a lag in this measurement, however, and I'm cautiously optimistic that if we have another week of lower total positive tests and lower test positivity, Rt will go below 1.0.

The Ugly: Hospitalizations, while not higher than last week, are still really, really high. Here's how it breaks down:

• Statewide COVID hospitalizations went from 1,258 to 1,243 this week, according to the Kansas Hospital Association.

• Statewide cases in ICU went from 279 to 250. 

• COVID hospitalizations in the Wichita area rose from 277 to 294, but cases in ICU fell from 80 to 72.

• COVID hospitalizations in the KC area (bistate) fell from 1,371 to 1,224 and cases in ICU fell from 250 to 220. 

• Overall ICU availability in the KC area rose from about 11.4% to about 13.7%, but regular hospital beds remained at about 15% capacity available. Basically, there's a little bit more cushion in KC this week, but not much. 

Kansas COVID-19 Update, Week 77

 

Things continue to be rough in Kansas. We've now basically equaled our previous peak of covid hospitalizations set in December 2020, although we haven't quite reached our ICU admissions peak. It is hard to fathom how this happened, given that this year we have vaccines and in December 2020 we did not. But vaccines are only good if people receive them. KU Hospital's daily covid updates have generally shown that about 90-95% of their covid patients are unvaccinated. A Kansas City Star article this week showed similar numbers for Saint Luke's (10 vaccinated covid patients out of more than 200 hospitalized for covid). Large numbers of unvaccinated people plus new more contagious variants is a recipe for disaster. The CDC is out with new data this week showing that with boosters the vaccines continue to hold up extremely well against Delta and Omicron. This is the key to getting us out of this bleak winter: getting vaccinated, getting boosted.

The Good: The infection reproduction rate, Rt, is back down to 1.1 this week after that insane jump to 2.7 last week. That suggests that it might have been a data fluke like I had hoped. We still want to get this number below 1.0 though. That's the only way to provide some light at the end of the tunnel for our hospitals.

The Bad: Test positivity rose from 42.5% to 43.4% this week, according to Johns Hopkins. Not a huge jump, but it was already quite high. Kansas is fifth in the country behind Alabama, Alaska, New Jersey and Utah.

The Ugly: Here are the hospital numbers:

• Statewide COVID hospitalizations are up from 1,128 to 1,258 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 271 to 279. The bar to getting admitted to an ICU is extremely high right now. All 279 of those people are extremely ill.
• COVID hospitalizations in the Wichita area rose from 253 to 277, and cases in ICU rose from 77 to 80.
• COVID hospitalizations in the KC area (bistate) rose from 1,294 to 1,371 and cases in ICU rose from 246 to 250. 
• Overall ICU availability in the KC area fell from 12.5% to about 11.4%. Even regular hospital beds were down to about 15% capacity available, which is as low as I've seen it. Given the staff shortages, hospitals are functionally full. Bursting at the seams, in fact.

Kansas COVID-19 Update, Week 76

 

I'm going to keep this short and sweet, because everything is bad. Now is not a good time to need hospital care, for any reason. 

The Bad: Test positivity in Kansas rose from 36.9% to 42.5% this week, according to Johns Hopkins. That's fourth-worst in the country, behind Alaska, New Jersey and Utah. 

The Worse: Things continue to get tougher for our hospitals:

• Statewide COVID hospitalizations are up from 987 to 1,128 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 242 to 271.
• COVID hospitalizations in the Wichita area rose from 209 to 253, while cases in ICU there rose from 62 to 77.
• COVID hospitalizations in the KC area (bistate) rose from 1,047 to 1,294 and cases in ICU there rose from 213 to 246. 
• Overall ICU availability in the KC area actually rose from 9.14% to 12.5% and the raw number of ICU beds available rose from 50 to 77. That means that there are fewer people in ICU for non-covid reasons this week, which gives KC hospitals a lucky bit of breathing room, but not any lasting relief.

The Ugly: The infection reproduction rate, Rt, soared from 1.1 to 2.7 this week. That's an enormous jump; definitely the biggest I've seen in Kansas from one week to the next. My hope is that this is a fluke of data — like maybe there were a lot of backed up tests during the holiday season that all got processed and reported in a big data dump this week. If not, then the virus is spreading incredibly fast in our area and our hospitals are in a very big bind.

Bonus: Amid all of this badness comes a new analysis that found that insurance companies and Medicare spent almost $130 million last year on ivermectin, a prescription drug that has not been proven to prevent or treat covid, but has nonetheless gained a rabid cult following among people who think it does (kind of like hydroxychloroquine in 2020). Ivermectin is extremely cheap by the pill and is usually only prescribed to treat very rare parasitic infections, so that huge price tag suggests that a whole lot of Americans have been taking it for covid (which, again, doesn't work, according to the published clinical evidence). Insurance companies don't have to cover these "off-label" uses, but it seems as though a lot of them have been because, again, ivermectin's pretty cheap on a per-pill basis so maybe not worth challenging each claim. In the grand scheme of America's total health care spending, $130 million is not a ton (though it's not chump change either). But that number still illustrates how much medical misinformation has taken hold of our population. 

 

Kansas COVID-19 Update, Week 75

Well, if you've been paying any attention, you know things are bad right now. Yes, Omicron is less severe, some percentage of the people who get it will still have to be hospitalized, especially if they're unvaccinated. And right now it's spreading so fast that even that small percentage is enough, in raw numbers, to overwhelm hospitals. Hospitals in some highly vaccinated regions are seeing lots of people with "incidental covid," meaning they were hospitalized for something else and then tested positive for covid in the hospital, but don't really have covid symptoms. This is the Omicron effect. It does not result in as much of a net increase in hospitalizations (although it does still strain resources because those patients have to be isolated). But that does not seem to be what's going on in our region. Our hospitals seem to be fighting a double whammy: severe covid cases caused by unvaccinated Delta and Omicron patients, and staff shortages driven by mild Omicron breakthrough infections. We haven't yet matched last winter's high-water mark for covid hospitalizations (about 1,250), but we're close (about 1,000) and our hospitals have less capacity to deal with it this year.

The Good: The infection reproduction rate, Rt, is still at 1.1 according to the site I use. It's good that it hasn't increased, but we're still above the level where cases would start going down. The curve, while not any steeper, continues on an upward trajectory. 

The Bad: Test positivity in Kansas is 36.9%, according to Johns Hopkins (I'm citing calculation Approach No. 5, since that is the one that allows comparisons to the most other states). That's fourth-worst in the country behind New Jersey, Alabama and Utah. 

The Ugly: Here's this week's hospital situation:

• Statewide COVID hospitalizations are up from 827 to 987 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 232 to 242.
• COVID hospitalizations in the Wichita area rose from 181 to 209, while cases in ICU there fell from 66 to 62.
• COVID hospitalizations in the KC area (bistate) rose from 840 to 1,047 and cases in ICU there rose from 196 to 213. 
• Overall ICU availability in the KC area fell from 10.02% to 9.14%. There are about 50 ICU beds left in the entire metro area. And this is a metro with about 25 hospitals. Every facility is basically full, or nearly full.  

Bonus: As of Saturday morning, KU Hospital (the largest in the state) was reporting 139 covid patients. Only 8 were fully vaccinated (the hospital's FB page has helpfully clarified that "'Fully vaccinated' is someone who has received two doses of the respective mRNA vaccines or one shot of the Johnson and Johnson vaccine. Booster shots are not included in the definition.") I just don't know how anyone can look at those numbers and say the vaccines aren't working. If they weren't doing anything, we would expect about 55% of those hospitalized to be vaccinated (because about 55% of all Kansans are fully vaxxed). Instead, it's about 6%. The effect of the vaccine is even more striking if you adjust for age. The Kansans who should be most at risk of hospitalization (the elderly) are 90% fully vaccinated, while the unvaccinated (including 0-5 year-olds) skew young and should have less hospitalization risk. Yet it's the younger, unvaccinated half of our state's population that is swamping our biggest hospital. If that isn't an ironclad argument in favor of vaccination, I don't know what is. 

Kansas COVID-19 Update, Week 74

 

Skipped the blog last week to spend time with family over Xmas. Consequently, all of the numerical comparisons this week will be to numbers from two weeks ago. It wasn't pretty then, and it's worse now.

The Good: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. That's good if it's accurate because it means our new cases have plateaued. But right now they're at too high a level for our health career system anyway, so a plateau is not good enough. We need a reduction in new cases, which will only happen if this number falls below 1.0. And even then, there's going to be some lag before hospitals feel relief. 

The Bad: Test positivity in Kansas rose from 48.3% to 62.0% this week, according to Johns Hopkins. Sounds crazy high, but seven other states (Rhode Island, DC, Delaware, Pennsylvania, Wyoming, Indiana and Missouri) are even higher now. It's bad all around. But without more testing we can't be fully confident in our Rt number.

The Ugly: Here's the hospital situation:

• Statewide COVID hospitalizations are up from 758 to 827 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 199 to 232.
• COVID hospitalizations in the Wichita area rose from 169 to 181 and cases in ICU there rose from 59 to 66.
• COVID hospitalizations in the KC area (bistate) rose from 727 to 840 and cases in ICU there rose from 150 to 196. 
• Overall ICU availability in the KC area fell from 12.75% to 10.02%. This is critical.

Bonus: The combination of rising COVID hospitalizations and staff shortages due to infection are pushing hospitals across the state to the brink. Topeka's largest hospital had to stop accepting patient transfers just before Christmas. Wichita's hospitals are treating people in ER waiting rooms, where some of them have been stuck for days, waiting for a bed. Things are no better across the state line, where Missouri hospitals are enduring some of the nation's worst staffing shortages. All of which means that the big hospitals that normally take in critically ill patients from rural facilities are often no longer able to, and Kansans who need a higher level of care are increasingly stuck in those smaller, lesser-equipped hospitals. And these aren't just COVID patients, either. Everyone who needs an ICU bed in the state for any reason is potentially in a bind now. Much of it is preventable, too. Wesley Medical Center, one of the state's largest, reports that about 95% of its COVID patients are not fully vaccinated. As of Friday, KU Hospital (which is the state's largest) reported that only 5 of its 104 COVID patients were fully vaccinated (odds are those five have some sort of condition that impairs their immune system, like an organ transplant or cancer treatments). Kansas is showing that during Delta/Omicron surge, if you have about half your population vaccinated, your health care system can still be crushed by the other half that's not vaccinated.