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.”
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