Kansas COVID-19 Update, Week 24

 

The statistical indicators headed into the holiday weekend were pretty good, overall, but our hospital capacity cushion remains small (especially in Wichita), so hopefully we won't see much of a post-holiday surge of new cases. Already, many more Kansans are without their loved ones this year. We recorded another 500 deaths in the last two weeks, topping 2,500 just before Christmas. We've been averaging 40 to 50 COVID-19 deaths every day in Kansas lately. And that probably won't slow down markedly for another week or two, because deaths are a lagging indicator. 

The Good: The infection reproduction rate, or Rt, fell to 0.95. That's a bit lower than last week, and two straight weeks below 1.0 is a good signal that we've reached the peak of infections and are trending downward. It will take some time for that to produce markedly better hospital capacity, however.

The Bad: Hospital ICU capacity was 21% statewide as of Dec. 23, according to the Kansas Hospital Association. That's a little better than the week before, but there are still some trouble spots, like south-central Kansas, where Wichita's ICUs remain over capacity. 

The Ugly: Test positivity was 29.5% this week, according to Johns Hopkins. That, too, is better than it has been, but still nowhere near where we need it to be. It's the sixth-worst mark in the country (behind Idaho, Pennsylvania, Alabama, South Dakota and Iowa).

Bonus: We're making gains, heading in the right direction, but I wouldn't be at all surprised if we lose some of those gains in the coming weeks, at least temporarily. Because the coronavirus spread is actually sort of predictable. Take a look at this chart of daily new cases from the KC Star:

Notice how cases rise fast throughout November. That's the autumn/winter spike that public health officials had warned would probably come. Then Kansas City area counties put new restrictions in place and, after about one incubation period, new infections start to trend down. Then Thanksgiving comes, with gatherings that public health officials warned could spread the virus and, about one incubation period later, there's another spike. Thankfully, that spike is pretty small and already seems to have petered out. But public health officials have been warning that gatherings for Christmas, New Year's, and other holidays could lead to yet another spike. Hopefully we are listening to them. Because it seems like they've been right a lot lately. 

Kansas COVID-19 Update, Week 23

 

We have reached a bit of a plateau in Kansas: hospitals remain pretty full and the COVID death rate remains dispiritingly high, but things are neither getting rapidly worse, like they are in California (where new cases rose 120% between Dec. 3 and Dec. 17, as compared to the previous two weeks), or steadily better, like they are in Minnesota (where new cases fell by 31% over that time). The rate of new cases in Kansas has flattened out, but it's still near the highest level it's been throughout the entire pandemic. Which makes us vulnerable to a big surge around special events, like Christmas or New Year's, if too many people gather and spread the virus around. Or, we could hunker down for a few weeks more and really turn this thing around so dozens of Kansans aren't dying every day with a vaccine that could have saved them in sight.

The Good: The infection reproduction rate, or Rt, dropped to 0.97. That's the lowest it's been since May and it's excellent news because it means that if we limit the virus to its current rate of spread (by wearing masks, social distancing, washing hands, avoiding large gatherings, etc.), we will not just flatten the curve, but bend it down. 

The Bad: Hospitals have yet to really feel much relief. ICU capacity in Kansas was about 18% as of Dec. 18, according to the Kansas Hospital Association. We'd like to get that above 20% to really feel like everybody can get the type of care that will give them the best chance to survive. As mentioned in prior weeks, the capacity is not evenly distributed. Just 7% of ICU beds were available in south-central Kansas, which is largely because Wichita's hospitals remained at capacity for the seventh straight week. While new cases are finally declining in the western third of the state, the center of the state remains red-hot (see heat map below), which will continue to strain ICUs in Wichita, Salina and Hays. 

The Ugly: Test positivity was largely unchanged, at a ghastly 37.7% this week, according to Johns Hopkins. That's fifth worst in the country behind Idaho, South Dakota, Alabama and Pennsylvania. We haven't tested enough since the beginning of the pandemic, and we still aren't testing enough. At the beginning we just didn't have the capacity to test enough, but now I think we do. I'm guessing some of our shortfalls now stem from geographic challenges (it's a long drive to a testing site in some parts of the state) and COVID fatigue (people with a known exposure or mild symptoms who might have previously gotten tested are now just kind of over it and will wait and see if they get sick). Consequently, a high percentage of the people who are getting tested are probably acutely ill, and therefore more likely to test positive. 

Bonus: Here's a striking statistic for you: Nemaha County, along the northern border of Kansas, has about 10,000 people in it. Douglas County, where Lawrence is located, has about 122,000. Yet more people have died of COVID-19 in Nemaha County (43), than in Douglas County (31). In fact, Douglas County has one of the state's lowest COVID death rates, per capita, despite tens of thousands of college students moving in and out of Lawrence (and partying) during the pandemic. Douglas County has had a mask mandate since June; steady, consistent messaging about masks, social distancing and hand hygiene; lots of testing (both on the KU campus and off); and a willingness to close bars and limit gatherings when community spread is high. Some people think those interventions don't make any difference. I think they do. If Douglas County were merely at the state average for COVID deaths (about 80 per 100,000 people), close to 100 residents there would have died of COVID now. Douglas County's response to the pandemic has probably saved 60 to 70 lives.  

Kansas COVID-19 Update, Week 22

Kansas has recorded yet another 500 COVID-19 deaths, this time in about 2.5 weeks. It took six months (from March 11 to Sept 11) for Kansas to record its first 500 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. Two weeks ago I predicted Kansas would top 2,000 total COVID deaths by Christmas. We got there two weeks earlier. Now it looks like we will top 2,500 deaths by Christmas. It's easy to get numb to all this death. But we're losing dozens of Kansans a day to COVID and each of them has a family that loves them dearly.

The Good: The infection reproduction rate, or Rt, dropped to 1.01 last week. That's a good number that suggests the Thanksgiving surge could be short. We're almost to the point where cases would start to decline. We desperately need an extended period of declining cases.  

The Bad: ICU capacity remains stubbornly low, at 17% statewide as of Dec. 11, according to the Kansas Hospital Association. That's about the same as last week, and persistently full ICUs are likely playing a role in the large number of deaths. Some of the Kansans in those beds probably would have survived if we hadn't spread our medical system so thin. 

The Ugly: Test positivity was 37.1% in Kansas this week, according to Johns Hopkins. That's better than the week before, but still awful. It's the fourth-worst rate in the country, behind Idaho, South Dakota and Pennsylvania. 

Bonus: When the pandemic first came to Kansas it came mostly to the urban areas. But for the last few months it's been overwhelmingly a more rural disease — so much so that the rural parts of the state have now borne a much greater overall disease burden than the urban parts. In past weeks I've occasionally shared a "heat map" that shows which areas of the state are recording the most NEW cases per capita. That's useful because it tells you where the virus is spreading right now. But here's a map that shows which counties have recorded the most CUMULATIVE cases per capita, going all the way back to the beginning of the pandemic. 

It's striking, isn't it? You can see that the pandemic has hit hard in Wyandotte County, but nearly every other "deep red" county is rural. The coronavirus has ravaged basically the entire western third of the state, and many of those cases have come in just the last few months. Early on in the pandemic, that part of the state was largely COVID-free, except for some outbreaks in meat packing plants, prisons and nursing homes, where chains of infection were easy to identify and contain. But in the last few months that part of the state has witnessed persistent, out-of-control community spread.

It's had devastating consequences for a lot of families out there, too. Here's another heat map, this one depicting cumulative COVID deaths per capita since the beginning of the pandemic. 

As a proportion of their population, rural counties have now become much more acquainted with death-due-to-COVID than their urban counterparts. In fact, tiny Gove County, Kansas (population 2,600), has had more COVID deaths per capita than anywhere else in the country. And yet, those counties are much less likely to require residents to wear masks. Gove County's government approved a mask mandate in August, but then repealed it almost immediately amid intense anger from locals (someone apparently even threatened to blow up one county commissioner's house). Even in rural places where masks are technically required, like Dodge City, resistance to wearing them remains high. It is sad, but I'm not sure what it will take to get those attitudes to change. An awful lot of death in a relatively short period of time hasn't done it yet.  

Kansas COVID-19 Update, Week 21

 

After a brief dip in new cases, COVID-19 is once again on the march in the Kansas City area and the state of Kansas. We are experiencing the predicted Thanksgiving surge (following the incubation period), and can expect another week or two of increasing infections until they hopefully start to level off and go down again. Then we'll have to deal with the Christmas surge. No good news in the data this week.

The Bad: The infection reproduction rate, Rt, ticked up from 1.05 to 1.07. That means each infection now causes, on average, 1.07 more. So while it may not look like a huge jump, it translates to a LOT more infections because we're starting from like 3,000 per day. We really need this number under 1.0. But Thanksgiving gatherings made an increase predictable. Hopefully it's temporary.

The Worse: ICU capacity fell from 21% last week to 16% on December 4, according to the Kansas Hospital Association. After a brief respite, we're back down to where we were two weeks ago. The Wichita area continues to be particularly strained, with just 5% of ICU beds remaining. And remember, Wichita's hospitals have already put in place their "surge" protocols and added extra ICU beds. They've been above their normal ICU capacity for more than a month. Now they're also bumping up against their surge capacity. It's a very difficult time to be a hospital worker or a patient in Wichita. 

The Ugly: Test positivity in the state rose from 38.1% to 46.6%, according to Johns Hopkins. That's third-worst in the country behind Idaho and South Dakota. It's a terrible number and it suggests that new infections are rising even faster than we currently think they are because many are going unidentified.

Bonus: I don't know what more can be done to convince people to wear masks, or to convince political leaders to require masks. We now have much better mask coverage in Kansas than we did just a month ago, thanks to Gov. Kelly's second mask order. But there are still dozens of mask-free counties in the state. Many of them are in western Kansas. Here's an updated heat map that shows where the most new cases, per capita, are being recorded.

To be clear, the yellow and orange counties aren't great. We could use more greens. But look where all the red is. Those counties are major COVID incubators. That affects the whole state, because the virus doesn't respect county lines and hospital patients are routinely transferred across county lines. Hays Medical Center's medical director said this week that nearly all of her hospital's COVID-19 cases come from counties that don't require masks.

I get that all counties are different and I'm a fan of local control for a lot of things. But viral pandemics aren't one of them. Ideally we should have a cohesive national strategy for containing COVID-19, but in the absence of that we should at least have a cohesive statewide strategy, especially given that the coronavirus is now endemic in every region of the state. The county-by-county patchwork approach is making things worse.

A binding statewide mask mandate would still help. In North Dakota, Gov. Doug Burgum instituted one on Nov. 13, after months of resistance. A Carnegie Mellon survey of Facebook users showed that the percentage of North Dakotans who reported wearing a mask rose to almost 90% after Burgum's order (it had been under 70% about a month earlier). Active COVID-19 infections have been cut almost in half there since the order.  

Now that's just one state and masks are just one factor (Burgum also ordered bars and restaurants to limit capacity to 50% and close at 10 p.m.). But it's yet another data point in a long and growing list that shows that masks reduce the spread of COVID-19 — with virtually no downside to those who are required to wear them. It's senseless that there are still dozens of counties in Kansas where people can gather, indoors, without wearing them.