Kansas COVID-19 Update, Week 20

 

The "grim milestones" are coming faster now. It took six months (from March 11 to Sept 11) for Kansas to reach 500 COVID-19 deaths. It took about six weeks (from Sept. 12 to Oct. 28) to record another 500. Then four weeks (from Oct. 29 to Nov. 23) to record yet another 500. Given the current ICU numbers, the state's death rate is not likely to slow in the near future. It's more likely to accelerate. Which means we'll probably hit 2,000 COVID deaths by Christmas.

The Good: The infection reproduction rate, or Rt, fell from 1.06 to 1.05. We could really use a bigger drop than that, given where we're at with hospitalizations. But we moved closer to the magic number of 1.0, so that's good. We're already seeing new cases taper off in parts of the state that put new infection control measures in place, like the Wichita area and Kansas City area. 

The Bad: ICU capacity improved a bit, going from 16% availability to 21%, according to the Kansas Hospital Association. But there are still very worrisome trends underneath those numbers. ICU capacity remains totally tapped out in southwest Kansas, and nearly tapped out in south central Kansas, which is no surprise given that Wichita's big ICUs have been over capacity for a full month now. And the state has 292 COVID-19 patients in ICU, which is yet another record. Which means the new capacity is from adding ICU beds and having fewer non-COVID patients. We can't count on that going forward. 

The Ugly: Test positivity went up, from 35.1% to 38.1%, according to Johns Hopkins. Not as high as it was two weeks ago, but still way too high and now trending the wrong direction. This means we're missing more infections than we were the week before — and we've been missing far too many infections for months now. 

Bonus: Gov. Kelly's decision to issue a second mask mandate appears to have paid off. This time, most counties didn't vote to opt out. More than half of the counties in Kansas (about 70 out of 105) now require masks. This was a pleasant surprise for me. I expected more of the local officials in rural areas to buck the governor's order, given the politics of the situation. But this gives me hope that masks aren't as politicized as I thought (although it should be noted that county commissioners voted to opt out again in some of the areas of SW Kansas hardest hit by COVID-19, like Ford County and Seward County, which is mind-boggling). 

The new mask rules also give me hope that we might see new daily cases start to decline statewide in about 10 days (after the incubation period), which would then results in fewer hospitalizations in about two weeks. The big wild card in all this, though, is Thanksgiving. If too many people decided to ignore public health recommendations and gather together in person, then we will likely see a spike in the next two weeks, rather than a decline, even with the new mask order. Either way, the death rate is likely to march on dispiritingly in the short term. Many of those 292 Kansans currently in ICU with COVID are not going to make it.  

Kansas COVID-19 Update, Week 19

 

We're entering the bad times now. The days of overflowing hospitals and overburdened health care workers that first plagued Wuhan, then northern Italy and then New York City are now coming to Kansas, as unlikely as that once seemed. Wichita's ICUs are over capacity (231 patients as of Nov. 16, vs. a capacity of 208). Topeka's hospitals reached capacity last week and started boarding patients in hallways. They've now requested staffing help from the National Guard and FEMA. The Kansas City region still has some ICU capacity, but it's going fast, hovering between 10% and 20% availability most days. And it's harder to staff those beds because health care professionals are getting COVID too. 

All of which means delays in care and preventable deaths – for Kansans with COVID-19 and other conditions — for the foreseeable future. There are some signs that maybe new cases are finally leveling off in the KC area, but they're plateauing too high to be sustainable. And exponential growth in new cases continues in the western half of the state. The next few weeks are baked in, they will be bad regardless of what we do because the record new infections we are seeing will become record hospitalizations. But there are some reasons to be optimistic that we can shorten the really bad period, and make it less bad, if we do the right things.

The Good: The infection reproduction rate, or Rt, was 1.06 this week, down from 1.20 the week before. This is my glimmer of hope. To be clear, 1.06 is still too high. Anything above 1.0 means the number of active infections will continue to rise, and they're already at an unsustainable level. But COVID goes in waves, and the significant drop in Rt means we may be reaching the crest of this particular wave. I already noted that the pace of new infections is leveling off in the KC area. In Lawrence, it has actually begun to go down in the past week. That's what we need to see in the whole state. Both KC and Lawrence have mandated masks for months, and have occasionally taken other measures, like closing bars or limiting their hours. Some people think this is a coincidence. I obviously do not. Gov. Kelly issued a second mask mandate this week, but, like the first one, counties will be able to opt out of it, per the Legislature's orders. I hope that most won't. Based on this heat map, the part of the state that is now seeing the most new cases per capita is western Kansas, where most counties have no mask rules. 

The Bad: The test positivity rate in Kansas last week was 35.1%, according to Johns Hopkins. On it's face, that is a really bad number. But again, it's important to see it in the context of where we've been: It was 58.7% the week before. So although we're still confirming more cases, we're also testing more. Which means we aren't missing as many cases. Which is an important step in getting this thing under control. 

The Ugly: ICU capacity statewide fell to 30% this week, according to KDHE, including another record-high 279 COVID-19 patients in ICU (which means more than 1/4th of the state's total ICU beds are occupied by COVID patients). And it's actually worse than that. KDHE's data, in the spirit of good old government efficiency, is reported by hospitals to the feds, who then feed it into a computer program and send it back to the states. By the time it gets out to the public, conditions have changed. And it also includes pediatric ICU beds in children's hospitals. Fortunately, the Kansas Hospital Association is now publishing its own data directly. It shows that as of Friday only 16% of staffed adult ICU beds in Kansas were available (including one single bed in all of southwest Kansas). This is a major problem, given that our COVID wave is still peaking and flu season has barely begun. December is when influenza usually starts in earnest in Kansas. Which means that as bad as things are for hospitals now, they're about to get worse. November 2020 will go down in history as the month Kansas hospitals were pushed to the breaking point. Barring a miracle, December will go down as the month when they were pushed past it. 

Bonus: Let me start off this section by saying that Kansas House Speaker Ron Ryckman did read my open letter and called me to discuss it. He deserves credit for responding, and his response shows the power each of us have in state level politics. You can find your elected representatives, and their contact info, on this site: http://www.kslegislature.org/li/. I highly recommend you let them know how you're feeling.

I'm not going to get into the details of my conversation with Speaker Ryckman because he asked me not to. But I will summarize it by saying that although he believes in wearing masks, he doesn't think mandating them would work, because Kansans don't like the government telling them what to do. In a certain sense, I agree: another mandate from a Democratic governor, like Laura Kelly, probably is not going to move the needle much in parts of the state that are overwhelmingly Republican, because masks have unfortunately become a political litmus test. I still think that a mandate strongly and publicly supported by a bipartisan group that included Ryckman and other Republican leaders would increase mask wearing. I wish that would happen. But it doesn't look likely, and even if it happened today, our hospitals would still be in trouble for the next couple weeks. So what's a family to do? 

My suggestion: hunker down. Limit the time you spend out of the house and avoid interactions with anyone who doesn't live in your house. That means:

• Work from home if you possibly can. Tell your employer it's what the CDC recommends. If your job doesn't allow you to work from home, I'm sorry. The rest of us should do our best to make it safer for you to work. 
• Don't travel: I know, I miss my family too, and I want to be with them on Thanksgiving. But it's not worth killing Grandma. Even if you're not concerned about COVID (for instance, if you've already had it and now have antibodies), there are large stretches of Kansas where, if you get in a serious car wreck now, you may not be able to get the care you need promptly.
• If you see friends, do it outdoors, at a safe distance. I know it's cold. Wear a coat. 
• Get groceries and other necessities delivered, or pick them up curbside.
• Support local restaurants with takeout or delivery (and leave big tips). Don't risk eating inside.
• Work out at home, but continue paying your gym dues, if you can, to support the employees. 
• Don't go to the bar (Congress should get off its collective ass and pay these businesses to stay closed in high-COVID areas, which is frankly most of the country now). 
• Manage your chronic conditions: Some hospitalizations are unavoidable (heart attacks, stroke, etc). But it's in your best interest now more than ever to stay out of the hospital if you can. Take your medications, exercise, eat right, get enough sleep, and stay in touch with your primary care doctor via phone, email or telemedicine.
• Get a flu shot: You should have already gotten one, but it's not too late. If you're not comfortable going to a doctor's office right now, get it at a pharmacy. 
• Buy a pulse oximeter: If you get COVID, you will be told to stay home, isolate and try to fight it off unless your condition worsens to the point where you absolutely need to go the hospital. This device, which clips on your finger and retails for about $20, will tell you if you've reached that point. It measures your blood oxygen level, and a general rule of thumb is that if that goes down to 90% or below, you should go to the hospital.

That's the best advice I have. Like I said, we're in the bad times now. As Pres. Lincoln once said, "This too shall pass." If we all do the right things, diligently and consistently, it will pass more quickly. 

Kansas COVID-19 Update, Week 18

Kansas descended further into the danger zone this week, as evidence mounted that our health care system is already struggling under the weight of COVID-19, with infections still climbing rapidly. Several of the state's largest hospitals, including Stormont Vail in Topeka and the University of Kansas Hospital in KCK, have now suspended elective procedures and put their "surge" plans in place, adding ICU beds for the crush of new patients. But the health care workforce is already overextended and with record numbers of new infections this week, no matter what we do, it's likely that some people who would have otherwise survived COVID-19 are going to die from lack of timely treatment. But that doesn't mean we shouldn't try to do something. If you're a train conductor and you see that there's another train on the tracks ahead of you, you apply the brake as quickly as you can. Even if you know you won't be able to stop in time to prevent a collision, you want to limit the number of train cars you end up plowing through.

The Good: The infection reproduction rate, or Rt, ticked down ever so slightly last week, from 1.22 to 1.20. That's not enough to prevent catastrophe, given our current rate of new infections. But at least it's trending in the right direction.

The Bad: ICU availabilty, as reported to KDHE by the federal government, was about 34% as of Nov. 12, or about the same as the week before. But that data seems incomplete, in part because while hospitals may be certified for that many beds, they may not have enough healthy staff for that many beds (health care workers are getting COVID too). The Kansas Hospital Association reported that as of Nov. 13, only 20% of staffed ICU beds were available statewide, and only 10% were available in the KC area. Regardless of which dataset you look at, we're at new record highs for COVID-19 patients in ICU (211 as reported to KDHE and 232 as reported by the hospital association). With more arriving every day. More than 20% of our ICU beds statewide are now taken up by COVID-19 patients, which is daunting considering we often exceed 80% of ICU capacity during flu season, even in non-pandemic years. Please pray for our health care workers, and do everything you can to support them in the coming weeks. Their physical and mental health are going to be severely taxed. 

The Ugly: Test positivity in Kansas rose to 58.7% last week according to Johns Hopkins, second-worst in the nation behind South Dakota. That's absurd. 

Bonus: Bonus content this week is an open letter to Ron Ryckman, a state representative from Olathe who is the Speaker of the Kansas House of Representatives. His email is ron.ryckman@house.ks.gov if you would like to write him too. 

Dear Speaker Ryckman,

Like many Kansans, I read that you were hospitalized for about a week in July because of what must have been a relatively serious case of COVID-19. I was glad to hear that you were discharged with a clean bill of health and hope your recovery has gone smoothly since. 

I don't know where you were hospitalized, but based on what I know about our hospitals here in Kansas City, no matter where it was, you probably got excellent care. And though I don't know you well personally, I know you well enough to believe that you sincerely want every Kansan to receive the same level of care. I'm writing to you because, by all accounts, we are approaching a point where that will no longer be possible and you, perhaps more than anyone else in the state, have the power and influence to do something about it.

You are a Republican leader who represents eastern Kansas, has roots in western Kansas, and can speak firsthand to the experience of being hospitalized with COVID. That is unique, and perhaps gives you the ability to convince your colleagues that we must change our current approach or our hospitals will be overwhelmed. (If you have kept in touch with any of the people who treated you in July, please ask them what things are like in their hospital today.)

A statewide mask mandate would be the most obvious thing to do, with the least negative consequences, practically speaking. You probably have heard people say that masks don't work (Lord knows I have). Fortunately, there is much evidence to the contrary. The CDC's mask recommendation is based on 45 different studies. 

There's evidence that masks reduce transmission of COVID-19 among people who live in the same state.

There's evidence that masks reduce transmission of COVID-19 among people who live in the same community.

There's evidence that masks reduce transmission of COVID-19 among people who live on the same ship. 

There's even evidence that masks reduce transmission of COVID-19 among people who live in the same house. 

There's also evidence that mask material reduced transmission of COVID-19 among hamsters in cages who were intentionally exposed to the coronavirus (an experiment that we can't do ethically on humans, but is useful because it stripped away all other possible explanations for the reduction in transmission).

I was heartened to see legislative leaders recently agree to something regarding masks: a $1.5 million allocation to the state hospital association for a public service announcement campaign. But this seems insufficient. By the time the PSA is produced and broadcast, our hospitals may already be full. And it doesn't seem like mask compliance is a matter of public awareness at this point. Most people are aware that health officials recommend wearing masks. Unfortunately there is a partisan divide in attitudes toward masks. A bipartisan mask mandate would send a powerful message that masks are not political, but rather just a tool to help Kansans protect each other.

I'm well aware that pushing for a mask mandate would put you crosswise with some of your colleagues. But I believe the politics of mask mandates is shifting fast as hospitals fill up. In just the last few weeks, very conservative leaders in extremely red states like Iowa, North Dakota, Utah and West Virginia have all enacted new mask requirements. 

Several of them also enacted new restrictions on gathering sizes, winter sports, and hours of operation for bars. Based on the epidemiological curve of COVID spread, we're only a few weeks behind those states in terms of hospital strain. No doubt many epidemiologists would recommend we take the same measures as them, and more. But at a minimum, shouldn't we do what has little-to-no negative practical consequences: require masks?

Think back to when you were in the hospital in July, probably on supplemental oxygen, since that is generally the benchmark for when a COVID-19 case requires hospitalization. But this time imagine that instead of being in a room, you're in a bed in a hospital hallway or an overcrowded emergency department. Imagine that even with an oxygen mask on, you start to find it difficult to catch your breath (a terrifying experience I'm unfortunately personally familiar with). Imagine that you're mashing the nurse call light, trying to get someone to help you, but no one comes. You can see medical personnel rushing around, tending to other people who are coding even as you grow more and more lightheaded yourself. But there just aren't enough of them. 

This is what we're heading for unless we do something to change our current trajectory. 

Sincerely,

Andy Marso

Kansas COVID-19 Update, Week 17

We're in a depressing phase of the COVID-19 pandemic in Kansas: record new cases, record hospitalizations, record ICU admissions and hospitals now under daily, ongoing strain. The novel coronavirus is circulating widely through nearly every corner of the state and the vast majority of our residents still have no immunity to it. It's like a fire that will continue to burn out of control unless we starve it of fuel by staying home as much as possible, staying away from other people when we leave home and wearing masks (made of several layers of fabric, over our mouths AND noses) whenever we are indoors with other people.

The Neutral: The infection reproduction rate, or Rt, is still estimated at 1.22, with a bottom-range possibility of 0.94 and a top-range possibility of 1.45. It's good that it didn't go up, but cases are so widespread now that anything above 1.0 really creates a damaging number of new infections. 

The Bad: ICU availability in the state was officially down to 33% on Nov. 5, and it's functionally lower (potentially much lower). As I wrote last week, hospitals (including KU, the biggest in the state) are opening overflow ICU beds because of the influx of patients. That has increased the total number of beds in the state past 1,100, but the problem, like I wrote last week, is that it's difficult to staff those beds. For example, at one point last week there were 32 open ICU beds across most of Kansas City, but only 22 that were actually staffed. Meanwhile, we keep setting new records for COVID-19 patients who need ICU care. Three weeks ago, the record was 128. This week we hit 183. 

The strain is being felt throughout the state. In Topeka, a destination for severely ill patients from a wide range of surrounding rural counties, there was only one available ICU bed at one point last week. As the county health officer pointed out, that means that if there had been a single serious auto wreck on Interstate-70 that day, the hospitals probably wouldn't have been able to handle it. Oh, and Wichita's hospitals actually reached full ICU capacity last week, meaning the same was true for Interstate-35. 

We are running out of places to send sick people. Barnes-Jewish in St. Louis, the largest hospital in the bistate region, is also reportedly near capacity and considering suspending elective procedures. 

So, even though on paper it looks like we still have more ICU beds, the on-the-ground reality is that the medical system is probably already strained to the point where some patients who would have survived will die because they can't get the attention they need as quickly as they need it. Hospitals can’t just create trained staff out of thin air. When New York City was swamped with COVID-19 in the spring, nurses came from all over the country to help. Now most are desperately needed in their home states. There is no cavalry coming. We are in deep trouble. 

The Ugly: Test positivity was up to 37.1% last week, according to Johns Hopkins, the fourth-worst in the country (behind South Dakota, Iowa and Idaho). Which means that we still don't know how bad our current outbreak is because we're missing a lot of cases. 

Bonus: I don't know what it will take for Kansans to realize what a fraught position we're now in with this virus. One would think that a county commissioner in Johnson County — which has by far the most robust health care infrastructure in the state — raising the specter of erecting temporary hospitals would be enough to do it. Well, that happened this week.

Commissioner Jim Allen, per the Shawnee Mission Post: “The numbers today are worse than they’ve ever been, and if people don’t take it seriously and these numbers keep going up exponentially we could be building temporary hospitals in Johnson County,” he said. “That’s how serious it is.”

And yet, in that same article the county's public health director says he's getting deluged by hundreds of emails a week urging us to just let the virus run through our population until we reach "herd immunity." That seems profoundly unwise, given that even with some minor mitigation measures in the county, like a mask mandate, our hospitals are already nearly full and COVID-19 is so prevalent that nursing home workers who have tested positive are still being allowed to come to work because there just aren't enough well people to replace them. Trying to reach "herd immunity" without a vaccine is a recipe for nothing but thousands of preventable deaths — and we don't even know how long the immunity would last (recent studies suggest COVID-19 antibodies wane quickly).

There is no reason to give up on trying to slow the spread of this virus. Other countries have done it very successfully; rich countries like Australia, New Zealand and Finland, as well as relatively poor countries like Uruguay, Vietnam and Rwanda. They took different approaches in terms of government intervention, but what they all broadly have in common is that their people listened to the advice of epidemiologists and public health officials and more or less did what they said, either voluntarily or because it was the law. 

That's the only path out of months of depressing death in Kansas: listen to the people who have studied infectious diseases their entire lives and do what they say, even if it's hard or inconvenient or ideologically unappealing. With every day that we fail to do that, the path narrows further.