Kansas COVID-19 Update, Week 16

 We're in trouble. The U.S. is setting records for new infections almost daily, creeping up on 100,000 a day. The Midwest has been at the center of the surge and Kansas has not been spared. Public health officials have warned us for months that this would happen – that infections would spread rapidly in the fall and winter, when respiratory illnesses always tend to be worse. They urged us to use the summer months to drive down case counts so that we'd be better prepared. States like Michigan and Minnesota, and certain counties within Kansas, that pursued phased reopening and required residents to wear masks have fared slightly better, with the surge coming later and less dramatically than in places like Wisconsin, Iowa, the Dakotas and western Kansas. But now it's basically a wildfire burning out of control and even people who cleared the brush around their own houses are in danger. Hospitals are filling up in several parts of Kansas and western Missouri, and it's having spillover effects on hospitals in others parts of the state. We could be in for a rough winter.

The Not-yet-bad: ICU availability clocked in at 36% in Kansas on Oct. 29, which isn't bad. But it's a bit of a mirage. Hospitals reported 145 COVID-19 patients in ICU that day, which would have been a record except that they reported 153 the day before. Our previous high was 128 two weeks ago. We blew past that three times this week. So why isn't the percentage of available capacity lower? A couple reasons. There are fewer people in ICU for non-COVID reasons than there were a couple weeks ago, but we can't expect that to last, given that flu season is just starting. And some hospitals, including the largest one in the state, The University of Kansas Hospital, are adding capacity by opening up overflow ICU units. It's obviously good that they're doing that, but staffing overflow units for extended periods of time can mean quality of care suffers. It requires a lot of overtime hours and people get burned out. 

The Bad: The infection reproduction rate is way up, to 1.22. This is not surprising. It's up almost all over the country. Last week I wrote that the actual rate was probably closer to the high end of the estimated range (1.29) than it was to the exact estimate of 1.06. Now the top end of the estimated range for Kansas is a dismal 1.45. Even if 1.22 is accurate, that means that every infection, on average, causes 1.22 more. When you're starting from about 1,000 new cases per day (where Kansas is now) you can see how quickly this thing spreads.

The Ugly: Test positivity in Kansas was 33.8% last week according to Johns Hopkins. That is just stunningly high, but somehow only fourth-highest in the country behind South Dakota, Wyoming and Iowa. In summary, we're setting records in Kansas for new confirmed cases, new hospitalizations and new ICU admissions, and we're still missing a significant number of infections based on our test positivity. All the trends are bad.

Bonus: A couple weeks ago Via Christi's hospital in southeast Kansas reached capacity and said it would be reaching out to the chain's other hospitals in Wichita and Manhattan for support and resources. Last week Via Christi's hospital in Wichita said it was nearing capacity and could take no more COVID-19 patients (Wichita's other major hospital, Wesley Medical Center, was 90% full). Wichita is a hospital catchment area for most of western Kansas, where ICU beds are scarce to begin with. Which is how you get this KCUR story about a patient in Kearny County, the far southwest corner of Kansas, who was rapidly dying of COVID-19 and needed an ICU bed and a ventilator, but the nearest available was in Kansas City, a seven-hour drive. 

We are all connected, whether we want to be or not, and the actions we take (or don't take) affect the people around us, and then ripple out to the people around them, and so on and so forth. So, please, wear a mask, don't gather in groups, try to keep things ventilated indoors as much as possible, and avoid unnecessary close contact with other people, even if you are wearing masks. Oh, and get a flu shot. It might keep you out of a hospital bed, and there's even some evidence it might reduce your risk of a severe COVID-19 infection. 

If 1,000 Americans were dying every day in a war, it would be all any of us were talking about and we would be desperate to change course. We are there now with COVID-19. 

Kansas COVID-19 Update, Week 15

 

The trends continue to go mostly in the wrong direction in Kansas, with the state setting another record Wednesday for 7-day average of new COVID-19 cases. And it's not just because we're testing more, because the percentage of tests coming back positive continues to rise as well. If you have rising case numbers and rising test positivity you can be fairly certain that you have rising infection rates. It shows in the number of deaths the state has recorded lately, as well.

The Good: It's a little hard to determine how COVID-19 specifically affected our hospital ICUs this week because the data is not coming in correctly from the feds. But the overall capacity looks to have held steady at about 35% most of the week. That's good, but I would very much like to know whether the number of ICU beds taken up by COVID-19 patients remains persistently high, like it was the week before. Hopefully HHS Protect gets that info published again soon.

The Bad: The infection reproduction rate (Rt) is up to 1.06. This was to be expected. The case growth we've seen in the past few weeks, coupled with the continuing rise in test positivity, could only mean that each infection was, on average, leading to more infections than before. In fact, if we were testing more, we would probably find that the Rt is more toward the upper end of the estimated range (1.29). At this point we know well what to do to get Rt down: keep your distance, don't gather in groups (especially indoors), and wear masks whenever you're out in public around other people. But if the large house party I observed across the street is any indication, some people still aren't getting the message.

The Ugly: Test positivity in Kansas is up to 19.9%, according to Johns Hopkins. That's eighth-worst in the country.

Bonus: One of the reasons our ICU capacity is holding steady is that a lot of COVID-19 patients are dying lately. As dark as it sounds, that frees up hospital beds. It took six months for Kansas to record its 500th COVID-19 death, on Sept. 11th. The state has recorded roughly another 500 in the six weeks since then. I know we're all tired of hearing the phrase "grim milestone," but at some point this week, Kansas will top 1,000 COVID-19 deaths, if it hasn't already (KDHE doesn't usually update the death numbers on weekends)(UPDATE: Kansas topped 1,000 deaths on Wednesday, Oct. 28, according to KDHE). According to the Federation of American Scientists, if Kansas were a country, it would have had the 12th-highest per capita COVID-19 death rate in the world during the week that ended Oct. 19 (Missouri would be in the top 10 and North Dakota would be the highest in the world).

My god, I cry so much for North Dakota and the Midwest right now. We are just at the beginning of the wave of deaths that are coming.

North Dakota has the highest mortality in the world. Higher than ANY country.

(Analysis by my FAS team. HT @euromaestro). #COVID19 pic.twitter.com/WirlY0o1AQ

— Eric Feigl-Ding (@DrEricDing) October 23, 2020

It's easy to get lost in these numbers, but we should not forget that each of those deaths was a person with a family and friends who will miss them dearly. One of them was John Hickman, a para-educator at a middle school in Olathe. Paras in the Olathe school district make about $13-14 an hour and Hickman, according to KCTV5, specialized in assisting students with special needs. 

We can't prevent all of these deaths, but we can prevent some. Masks work. According to one study released this week, people in states with higher rates of mask use are less likely to know people with symptoms of COVID-19. According to another study, universal mask wearing could save more than 100,000 American lives between now and February. We need to try to get as close as possible to universal masking in Kansas, because at our current rate of deaths, we're going to lose another 1,000 people by February. 

Kansas COVID-19 Update, Week 14

 

During the three-plus months I've been writing this blog, we've seen some tragic death numbers in states like Florida and Texas when hospitals became swamped with COVID cases. This is the first week that I've truly feared that scenario might be coming to Kansas. 

The Good: I can't really find anything good this week. The closest thing is that the infection reproduction rate, or Rt, only rose from 1.01 to 1.02. But that's still the wrong direction and based on the other data I wouldn't be at all surprised if the actual Rt number is higher and we're just not testing enough to find out.

The Bad: Test positivity is up again, now to 17.4%, according to Johns Hopkins. If you want to look for a silver lining there, I guess it would be that it's actually rising even faster in other states, so now Kansas is only ninth-worst in the country rather than fifth-worst. But that's just indicative of how bad things are going elsewhere. The test positivity numbers in the last couple weeks in states like Iowa and South Dakota have been truly appalling.

The Ugly: ICU availability was at 35% on Oct. 15. Now, you might say, "What's ugly about that? It's better than the week before." That's true, but here's the ugly part: we now know that the week before wasn't a one-time spike. We are clearly in a sustained period of high hospitalizations for COVID, including ICU hospitalizations. Prior to last week there was only one day in which Kansas recorded more than 115 COVID-19 patients in ICUs: an isolated spike of 121 on Sept. 24. But from Oct. 8 through Oct. 15 Kansas hospitals reported more than 115 COVID-19 patients in ICU every day, including a new record-high of 128 on Oct. 13. This is not a fluke, or an aberration driven by the unpredictable timing of ICU admissions and discharges. It's a troubling trend. 

Bonus: 35% ICU availability sounds OK, but it's not distributed evenly across the state. So I started looking for news stories about Kansas hospitals filling up, and man it didn't take long to find them. This Oct. 13 article from the Pittsburg Morning Sun says that Ascension Via Christi, one of the largest hospitals in southeast Kansas, suspended all elective surgeries because of the surge in COVID-19 patients. It's hard to overstate how serious that is. Tests and procedures are the financial lifeblood of U.S. hospitals because of the way our health care reimbursement system is set up (that's not good for patients, BTW, but that's a complex topic for a different time). So for Via Christi administrators to stop them, it must mean they're very concerned that they soon won't have the beds and/or staff to handle the patient load.

The county health officer said in the article that the situation at Via Christi is made worse because the hospitals it would normally refer patients to in Joplin, Mo., and the Kansas City area are also filling up (since the closure of Mercy Hospital in Fort Scott, there are very few hospital beds between Pittsburg and Olathe, a distance of 110 miles). Indeed, an article in the Kansas City Star said that eight hospitals or stand-alone emergency rooms were not accepting ambulances on Oct. 12 because they were too full to take more patients. The KC metro has an abundance of hospitals and ERs (about 35), so there were still plenty of places in the metro for patients to go. But to have eight on ambulance diversion at one time still suggests a surge of patients like what you might see during peak flu season — and flu season hasn't even started. 

It's no wonder that things are getting dicey on the east side of the state, given that both Kansas and Missouri have been reporting their highest seven-day averages of new daily COVID-19 cases of late. This "heat map" shows, in red, U.S. counties with the most new COVID cases per capita during the two weeks leading up to Oct. 15. You'll notice there's a whole lot of red throughout western Missouri.

Those are mostly rural counties without a lot of ICU beds, so many of the sickest patients from those areas will end up in regional hospitals in places like KC. Which can cause hospitals to fill, even if KC area counties themselves are not red. 

Another area you might notice has a lot of red is western Kansas. And yes, hospitals are filling up there too. Witness this Associated Press dispatch, in which the sheriff of Gove County gives a somewhat surreal phone interview while struggling to breathe in a hospital bed in Hays. The sheriff (who has since recovered) had COVID-19. So did the county's emergency management director, the CEO of Gove County Medical Center and more than 50 staff members at the medical center. Which was why the sheriff was in Hays, almost an hour away: the local hospital was full. 

And yet, based on the AP story, the leaders of Gove County have no intention of requiring people to wear masks. The county commission did require masks briefly in early August, when COVID-19 cases began to spike. But that only lasted 11 days. Then the commissioners caved to public pressure and repealed the rule. Which has to be frustrating for the people of Hays, which is mandating masks while their hospital fills up with patients from other counties. It's clearly frustrating for Tom Moody, a commissioner from Crawford County who said this in the Pittsburg Morning Sun article about Via Christi:

“We’re allowing these other counties that are doing basically nothing (to stop COVID-19) to fill our hospitals, which takes away from our county constituents,” Moody said. “Would it be beneficial if we tried to get a meeting with the other counties to let them know our feelings on this? Because to me it’s bullshit that they’re doing this, and it really upsets me.” 

This was an entirely predictable outcome of the Kansas Legislature undercutting Gov. Laura Kelly's COVID-19 orders and leaving it to each city and county to decide what measures they will or won't take to stop COVID-19 (and Gov. Mike Parson doing the same in Missouri). It's a virus, so it doesn't respect county borders. And most ICU beds are located in urban areas that are requiring virus mitigation measures, so they're going to take the sickest patients, even if they come from counties that aren't enacting any mitigation measures. 

Since the early days of the pandemic some political leaders have advocated a very light-touch approach from government, saying that citizens will voluntarily do the right things to protect each other. But there's a lot of evidence that's just not true, whether it's articles about people being openly hostile to businesses that try to require masks, or even threatening to kidnap and kill political leaders who support mask rules. 

Masks work. They are not a panacea, but they have been shown to reduce the daily growth rate of COVID-19 infections by 40%. Kansas could use every bit of that 40% as we try to keep our hospitals from filling up. The next month will be critical. 

As Chris Christie said earlier this month after barely surviving COVID-19:

“Every public official, regardless of party or position, should advocate for every American to wear a mask in public, appropriately socially distance and to wash your hands frequently every day.”

Kansas COVID-19 Update, Week 13

 

There was another spike in COVID-19 ICU hospitalizations in Kansas this week. It's not quite as high as the one two weeks ago, but still concerning, especially since overall capacity seems to have been more affected this time. Here's the weekly update:

The Good: The infection reproduction rate, or Rt, stayed at an estimated 1.01 this week. It's the third straight week at that number. We would prefer for it to be going down, rather than staying the same. But this is the best I can do in terms of silver linings this week: each infection doesn't seem to be causing more new infections than it did in weeks past. But once you get enough infections out in the community, any Rt number above 1.0 can cause significant problems. 

The Bad: One of those problems, eventually, will be overloaded hospitals, which we've previously seen in parts of New York, New Jersey, Michigan, Louisiana, Florida and Texas. We're not there yet in Kansas, but this past week was a step in the wrong direction. Kansas hospitals reported 119 patients in ICU because of COVID-19 on Oct. 8 (with 130 hospitals reporting). That was the second-highest number on record, trailing only the 121 from two weeks earlier. But while that previous spike didn't hurt overall capacity (ostensibly because fewer people were in ICUs for other reasons), this time it did. The percentage of ICU beds available in the state dropped from 37% the week before to 32% on Thursday. That's the lowest it's been since I started checking in early July, and flu season hasn't even started. So get your flu shot before the end of this month, and encourage everyone you know to get it too, unless you or they have a medical condition that precludes vaccination. 

The Ugly: It's always test positivity, it seems. It went up again this week, according to Johns Hopkins, rising to 16.2% in Kansas. That was fifth-worst in the nation, behind only Idaho, South Dakota, Wisconsin and Iowa. Twenty states (and DC) are below 5%, so it can be done. But it takes an awful lot of testing. 

Bonus: Our bonus this week comes courtesy of documents from the White House Coronavirus Task Force that were leaked to the Center for Public Integrity (don't ask me why the work product of a group of civil servants paid for with taxpayer money needs to be "leaked" to the public rather than just published). Task force documents from Oct. 4 show that the following Kansas counties were deemed in the "red zone" for having high numbers of COVID-19 cases per capita: Ford, Ellis, Finney, Crawford, Seward, Barton, Cherokee, Dickinson, Grant, Franklin, Pottawatomie, Thomas, Rooks, Stevens, Nemaha, Phillips, Cheyenne, Rawlins, Ness, Rush, Logan, Sherman, Sheridan, Gove, Marshall and Scott. That's most of southwest Kansas, a significant chunk of northwest Kansas, most of the area around Hays, a couple counties in southeast Kansas, a couple along the northern border with Nebraska (a state where hospital capacity is starting to become a real problem) and a couple near Fort Riley. The task force recommends that masks be worn in indoor public places throughout the state, but most of those red zone counties are quite rural and don't have any rules about mask wearing. Several urban counties that do have mask mandates fall into the task force's "orange zone" (Wyandotte) or "yellow zone" (Johnson, Sedgwick, Douglas, Shawnee). So masks aren't a panacea. But very few people are claiming that they are. Masks are an evidence-based way to reduce transmission of the novel coronavirus, at little to no cost to the wearer or society at large. Seems like a good trade. 

Kansas COVID-19 Update, Week 12

 

Obviously, it's been quite a week for COVID. With everything happening in DC, the news looks pretty mundane here in Kansas, but it's still worth keeping an eye on how things are going closer to home.

The Good: Last week we saw COVID-19 cases in Kansas ICUs rise to a record 121. This week that figure was down to 103, which is still a tad high but largely in line with where it's been the last few months. It should be noted, though, that only 120 hospitals reported data this week, as opposed to 130 last week. But available ICU capacity remained almost unchanged at 37% (as opposed to 36% last week). ICU numbers can fluctuate a lot from day to day, or even within the same day. People get better and are discharged from ICU, people get worse and are admitted to ICU, people in ICU pass away. So it's important to focus on the long-term trend, rather than just one data point. Right now, that trend still looks pretty stable (but a bit high). 

The Neutral: The estimated infection reproduction rate, or Rt, is unchanged from last week at 1.01 in Kansas. Interestingly, though, the folks who calculate it on the site I use have reduced the low end of the possible range from 0.80 to 0.77 (while leaving the high end at 1.21). That seems like a good sign, potentially.

The Ugly: Test positivity rose again last week to 15.9%, according to Johns Hopkins. That's seventh-worst in the nation, ahead of only Mississippi, South Dakota, Idaho, Wisconsin, Iowa and Missouri. Remember, when test positivity is above 5%, there's a good chance you're missing a lot of COVID-19 cases. Which of course makes tracing and isolating cases impossible and creates a "silent spread."

Bonus: This week's bonus comes from the blog (self-promotional, I know). It's a satirical homage to the idea that it's not the government's place to enact any COVID-19 restrictions. 

We should have no COVID-19 restrictions... or traffic restrictions

Author's note: This is satire. I don't actually believe any of this. I'd like to think that I don't truly have to explain that, but... that's kind of where we are now.

I’ve been listening to people who are against any government restrictions related to COVID-19 for several months now and, I gotta say, they’re starting to make a lot of sense. In fact, based on their arguments, I’ve come to an important conclusion: we must immediately repeal all traffic laws.

It’s become clear to me that these “rules of the road” are really just another example of egregious, nanny-state government overreach. By tolerating them, we as citizens have just moved, like willing sheep, one step closer to welcoming tyranny.

We must protect our right to drive the way we want to drive. The government should get out of the way and let everyone choose their own level of risk. If you want to stop at every red light or stop sign, fine. But I refuse to live in fear.

For years now we’ve been warned about the dangers of reckless driving. But did you know that only about 40,000 people in the U.S. die in traffic accidents every year? That’s about the same as the flu, and we don’t make people follow a bunch of rules just to prevent the flu.

Besides, the car wreck death count is obviously overinflated. How many of those people had other medical conditions, like obesity, at the time of the crash? A lot of them were probably going to die anyway. I bet doctors are just writing “car accident” on death certificates so they can get kickbacks from trial lawyers who are looking for big paydays suing auto insurance companies. My friend’s co-worker’s uncle knows a nurse who said she saw that happen once.

Most car wrecks aren’t even serious. I bet you didn’t know that, because the fear mongers in the media never show you the thousands of wrecks that are just harmless fender-benders. They concentrate only on the few here and there that end in violent dismemberment and death. So cynical.

Now the “morality police” (and also the actual police) keep telling me I have to wear a seatbelt. I can hardly get in a car with other people without them telling me to put it on. One time I even got pulled over by a cop who warned me that the next time I drove without a seatbelt I might get a ticket. I mean, is this America, or Soviet Russia?

I don’t believe in seatbelts anyway. Sure, a bunch of “experts” say they have “studies” that show they save lives. But where were all those experts in the 1950s? We had cars then, but no seatbelts. And some people who wear seatbelts now still die in car crashes. Really makes you think. Whenever I try to wear a seatbelt it feels like I can't breathe. That's probably the real danger: getting strangled by your seatbelt.

And what’s with all these capacity laws? How is the government going to tell me that I can’t put 11 people in my subcompact car, when there are vans and buses all over the road carrying way more people? How is one safe, but not the other?

Anyway, I’m done listening to the government or blindly trusting the “experts.” If cars had some kind of potentially debilitating condition that they could spread to other cars just by getting close to them, then maybe we would actually need traffic laws. But right now, I just don’t see it.