Kansas COVID-19 Update, Week 73

At this point you probably don't need me to tell you that things aren't going well. Kansas hospital leaders are sounding that alarm almost daily. We have not matched last year's peak of COVID hospitalizations yet, but they keep climbing. With more patients suffering from flu and other illnesses this winter, hospitals are already filling fast. Meanwhile new COVID cases continue to climb rather steadily, suggesting no relief around the corner. Omicron, which is here but probably not in huge numbers yet, could make it all worse, unless we get more people vaccinated and boosted.

The Good: The infection reproduction rate, Rt, remained at 1.1. It's the best news we have this week, but still not great, because as long as that number's above 1.0 the overall number of active infections will continue to rise. 

The Bad: Test positivity in Kansas rose from 47.3% to 48.3%, according to Johns Hopkins. That's second-worst in the country behind Wisconsin. Our testing numbers remain elevated from where they were a few weeks ago, but seem to have kind of leveled off. 

The Ugly: Here's the hospital situation broken down in chunks:

• Statewide COVID hospitalizations are up from 668 to 758, according to the Kansas Hospital Association.
• Cases in ICU statewide fell from 201 to 199.
• Hospitalizations in the Wichita are went from 159 to 169, and cases in ICU there went from 57 to 59. 
• Hospitalizations in the Kansas City area rose from 600 to 727, and cases in ICU there rose from 139 to 150.
• ICU availability in the KC area fell from 13.24% to 12.75%. 

Bonus:  Omicron will hit hard and fast. But the good news is, once we get through the surge, the decline should also be rapid. Breakthrough infections are a given with omicron, but booster shots can reduce them substantially and those that occur in fully vaccinated people are not likely to be serious, unless they're old or immunocompromised. 

Kansas COVID-19 Update, Week 72

We are smack in the middle of the fall/winter surge now. Thanks to vaccines our case numbers are not as high as they were last year at this time, but they're now the second-highest they've ever been, surpassing even this summer's Delta-driven surge. Delta is still circulating, people are increasingly gathering indoors, and the air is colder and drier which allows respiratory viruses to spread more easily. It's a dangerous combo. If this year's fall/winter surge follows the same pattern as last year's, we may see a bit of a lull in new cases in the next week or two, as the Thanksgiving infections resolve, then another spike after Christmas/New Year's, followed by a steady drop off in January and February. But no real relief for hospitals until probably mid-to-late February. 

The Good: Test positivity fell from 52.6% to 47.3%, according to Johns Hopkins. To be clear, that is still quite high (even based on Hopkins' methodology, which skews higher than others). It's still second-highest in the country, in fact, behind only Iowa. But there's been a clear increase in testing in Kansas. We've more than doubled our per-capita testing rate and, though we're still nowhere near the states that are testing the most, we're now ahead of seven states that are testing less. So, progress. Knowing who's infected is the first step to slowing the spread. This all comes with the caveat that at-home tests are making it increasingly hard to calculate test positivity (because results from at-home tests aren't usually reported, especially if they're negative). 

The Bad: The infection reproduction rate, Rt, rose from 1.0 to 1.1. This is to be expected. Cases are clearly on the rise. In fact, there's a good chance the true Rt is even higher than 1.1; but the increase in testing allows us to have a little more confidence in this number going forward.

The Ugly: COVID-19 hospitalizations are rising, and fast. They're up statewide this week from 545 to 668, according to the Kansas Hospital Association. Remember how I said last week that we were likely to see a surge in ICU admissions? Well, they're up from 138 to 201. The increase seems to be mainly in eastern Kansas. Wichita's hospitalizations actually dropped from 172 to 159 (and cases in ICU dropped from 58 to 57). But the KC metro's COVID hospitalizations rose from 505 to 600 this week (that includes hospitals on both the Kansas and Missouri side of the state line. Only 186 of those are included in the Kansas Hospital Association's statewide total) and ICU cases went from 128 to 139. ICU availability in the KC metro has fallen to 13.24%. Anything below 20% is dangerous. Anything below 10% is critical and probably means some patients aren't getting the care they need. 

Bonus: The picture on Omicron is becoming increasingly clear. It's more transmissible than past variants, but not more severe (and may even be less severe). It has more immune evasiveness than previous variants, but two doses of Pfizer or Moderna plus a booster or a prior infection seem to still provide pretty robust protection. So get those boosters if you haven't already.

Kansas COVID-19 Update, Week 71

Well, we're about a week out from Thanksgiving and we seem to be experiencing a significant spike in new cases as a state. It's having a worrisome effect on our hospital capacity. I know everyone is tired of hearing they should get vaccinated, mask up and social distance, but if we don't start doing more of all three, it could be a rough holiday season. Our COVID numbers are not as bad as last year's deadly winter surge, but this year we have more flu (probably because people have taken off their masks) and other illnesses to deal with at the same time. 

The Good: The infection reproduction rate, Rt, is still estimated at 1.0 (with a potential range of 0.86 to 1.3, which is a huge variance because of our lack of testing). But even that bit of good news is probably short-lived. Given the rate of new cases in the past few days I think once the data reporting catches up, that Rt number is almost certainly going to rise.

The Bad: Hospitals are increasingly crunched. COVID hospitalizations statewide are up from 478 last week to 545 this week, according to the Kansas Hospital Association.  That's only about half of the last year's peak hospitalizations (thank you, vaccines) but still a lot to deal with. Oddly, ICU cases are down, but only from 144 to 138. Given the increase in hospitalizations, I would expect that to change over the next week. Sedgwick County's ICUs are overloaded. COVID hospitalizations there jumped from 135 to 172, and cases in ICU went from 50 to 58. Kansas City area hospitalizations rose from 342 to 505 and cases in ICU went from 88 to 128. ICU availability in the metro area is down to 15%.

The Ugly: Test positivity rose from 42.4% to 52.6%, according to Johns Hopkins.  That's second-worst in the country, ahead of only Iowa. Only Iowa and Idaho are running fewer tests per capita. Vermont, the nation's leader in testing, is now running 22 times more per capita tests than Kansas. 

 

Kansas COVID-19 Update, Week 70

Not a lot of good news this week. New cases still going up. Hospitalizations too. There was also a one-day spike in deaths on Nov. 19, though that's not enough to establish a trend. This seems to be the winter surge. Last year our new cases peaked right around this time, at a rate more than twice as high, leading to extreme death in December and January. I think it would be naive to believe the peak will come at precisely the same time this year. We may be there, we may not be. 

The Good: The infection reproduction rate, Rt, remained at 1.0 this week. We aren't testing near enough to be confident in that exact number (the website I use gives us a range of anywhere from 0.83 to 1.5), but if that's right, it's good news because it means infections aren't increasing. But they're not decreasing either.

The Bad: COVID hospitalizations statewide jumped from 443 to 478, according to the Kansas Hospital Association. Cases in ICU are up from 114 to 144. Wichita's hospitals saw a steep rise in cases this week, from 97 to 135. Cases in ICU there dropped from 51 to 50, but given the overall hospitalization numbers, it's only a matter of time before those are back on the rise. Kansas City area hospitals had 342 COVID patients this week, including 88 in ICU. ICU availability remained at 20% there, though. 

The Ugly: Test positivity rose from 37.6% to 42.4%, according to Johns Hopkins. That's second-worst in the country behind Iowa. Kansas is also basically tied with Idaho for lowest per-capita testing rate. Vermont is testing 20 times more than Kansas. 

Bonus: About 600 passengers on two planes traveling from South Africa to Amsterdam were stopped upon arrival and tested for COVID, because of the new Omicron variant. Sixty-one tested positive, though it's still unknown exactly how many had the Omicron variety. This will be something to keep an eye on.  

Kansas COVID-19 Update, Week 69

It looks like the beginning of the winter surge is upon us. New cases are up, and hospitalizations are up too. For now, deaths still seem to be trending down from September/October levels, but deaths are of course a lagging indicator. This year's winter surge is not likely to be as bad as last year's, especially in terms of hospitalizations and deaths, because of the vaccines. But this year we also seem to have more people in hospital beds for non-COVID reasons. So, a friendly reminder: you can get your annual flu shot and a COVID booster at the same time.  

The Good: The infection reproduction rate, Rt, rose from 0.96 to 1.0 in Kansas this week. That qualifies as good news this week because the rest of the news is worse and also because, if you read last week's blog, you know that I wasn't super confident in that 0.96 figure anyway. In fact, given our lack of testing, I'm guessing 1.0 might be artificially low too. 

The Bad: COVID hospitalizations statewide rose from 393 to 443, according to the Kansas Hospital Association. Of those, 114 are in ICU. Hospitalizations in the Wichita area fell from 102 to 97, but the number of cases in ICU remained at 51.  ICU availability in KC area hospitals fell from 18% to 17%. 

The Ugly: Test positivity rose from 37% to 37.6%, according to Johns Hopkins. That's still fourth-worst in the country behind Iowa, Oklahoma and Idaho. And Kansas is still running the fifth-least tests per capita in the U.S. One caveat: these numbers, for the most part, don't include at-home tests. The news this week that Lee Norman is stepping down as KDHE secretary spurred me to go back and listen to an interview he did for the Kansas Reflector podcast in May. In it he predicted that the rise in at-home tests would skew test positivity numbers because negative at-home test results are almost never going to be reported, while most positive results probably will be eventually (when a patient gets a PCR test to confirm the positive). I can confirm that this has happened in my house. My wife and I have run several at-home tests, they've all been negative, and those negatives weren't figured into any official test positivity data. That could be playing a role in keeping Kansas' test positivity stubbornly high, especially if Kansans are relying on at-home tests more than residents of other states. 

Bonus: Throughout the pandemic I have found Eric Topol's Twitter feed to be invaluable. He's a physician-researcher with a "just the facts" style who does a really good job of spotlighting important, reliable studies and then putting their results in context. This week he spotlighted the first randomized, controlled trial to show the effect of COVID boosters. All 10,000 participants in the study had gotten two doses of the Pfizer vaccine earlier this year. One group was given a real booster, and the control group was given a placebo "booster." Both groups were then watched for two months. The results were striking: the group that got the actual booster saw their protection against symptomatic infection rise to 95% within seven days. And the best part? There were actually more adverse events reported by the placebo group than by the group that got the actual booster, suggesting it's extremely safe. Now, the people in the placebo group remained well-protected against severe illness from their first two shots — none were hospitalized for COVID and only two suffered a "severe" case (determined by an oxygen saturation level of 93% or below). But they were more likely to get an infection (which can still be pretty crummy, if not life-threatening) and therefore more likely to pass the virus along to others. Boosters are now open to all adults, and the data shows they can really help our communities stem the spread.     

Kansas COVID-19 Update, Week 68

The general pattern of the past month continues to hold. New cases remain high in Kansas, but not as high as they were in August or September, and they're not really increasing or decreasing much at all. I hope this is not the new normal. We're still averaging about 20 COVID deaths per week as a state, which would be more than 1,000 a year. While that's certainly a lot better than the first 12 months of the pandemic, when we suffered about four or five times that many deaths, it still seems like a pretty high price to pay. Hopefully vaccines for kids 5-11 will help reduce transmission.

The Good: The infection reproduction rate, Rt, fell from 1.0 to 0.96 this week.  The caveat to that is that getting a really precise Rt number relies on having robust testing in place, and there's ample evidence we aren't testing near enough in Kansas. 

The Bad: COVID hospitalizations statewide barely budged this week, going from 402 to 393, according to the Kansas Hospital Association. Cases in Wichita's hospitals fell from 113 to 102, but cases in ICU there actually rose from 48 to 51 and those hospitals remain over their normal ICU capacity. ICU capacity in the Kansas City area is also slightly more pinched, going from 22.5% to 18% this week. 

The Ugly: Test positivity rose from 33% to 37% this week, according to Johns Hopkins. That's third-worst in the nation behind Iowa and Idaho. Only five states are currently running fewer weekly tests per capita than Kansas. Four states (Vermont, Massachusetts, Rhode Island and Illinois) are each running at least 10 times more. That's why I can't be super confident about that Rt dip. 

Bonus: Children are at lower risk for severe COVID-19 than adults, but sadly some do get very ill from it, and some even die. We have seen it happen right here in Kansas, including again this week, with our sixth pediatric death of the pandemic. It's important to know that the new vaccine approved for kids 5-11 is a lower dose specially formulated for that age group. In clinical trials it provided robust protection (because kids that age have very responsive immune systems) without any evidence of the rare side effects (myocarditis) observed in some (mostly young men) who received the adult dosage. In fact, so far no serious side effects of any kind have been observed in the trial participants. It's a smaller sample size than the clinical trials for the adult vaccine, but so far the kids' dose looks extremely safe and effective.     

Kansas COVID-19 Update, Week 67

We continue to be in sort of a holding pattern in terms of new cases. After a steady decline through the month of September, we've been at essentially the same rate for more than a month. That rate is nowhere near last year's November/December surge, or even this summer's Delta surge, but it's still pretty high: about 1,000 new cases per day, in a state of 3 million people. That's far too many for us to trace and isolate, like we would with infectious diseases like measles. But the good news is that hospitalizations continue to fall, and a new drug that should keep more COVID patients out of hospital beds is on the way.  

The Good: Total COVID hospitalizations statewide fell from 454 to 402 this week, according to the Kansas Hospital Association. That's much better than the week before, when the number barely moved. Sedgwick County's ICUs remain over normal capacity, but their COVID hospitalizations fell from 133 to 113 this week. Unfortunately, cases in ICU only dropped from 50 to 48. ICU availability in the Kansas City metro rose from 20% to about 22.5% this week. Not a huge jump, but it's the right direction.

The Bad: The infection reproduction rate, Rt, once again stayed the same at 1.0. That tracks with our steady case rates. New cases won't fall until we get Rt below 1.

The Ugly: Test positivity stayed basically the same, going from 33.2% to 33.0%, according to Johns Hopkins. Still fourth-worst in the country behind Idaho, Iowa and Oklahoma. With Rt hovering right at 1.0, it would be nice if we could be more confident that we're testing enough to catch most infections. But we're not. 

Bonus: Colorado continues to feel a major hospital bed crunch, with only about 100 ICU beds available across the entire state (a population of almost 6 million, and more if you include all of the people who live in rural parts of surrounding states like Kansas and rely on places like Denver and Grand Junction for ICU care). COVID-19 is not the only thing driving the bed space shortage there, but it's definitely a factor. And it should be much less of one. About 35% of Coloradoans (the unvaccinated) currently account for about 80% of all COVID hospitalizations. Which suggests you have a much, much lower risk of hospitalization if you've been vaccinated. It's the same story all over. In the country of Luxembourg, the 30% of the population that's unvaccinated accounts for 82% of COVID hospitalizations. In Sedgwick County, the 37% of the population that's unvaccinated accounts for 88% of COVID hospitalizations. We have the tools to solve this problem. We just need to convince more people to use them.