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. 

Kansas COVID-19 Update, Week 66

We're at a plateau right now. New cases have leveled off and may even be rising again slightly. Hospitalizations are also barely going down now. I'm  concerned about the news coming out of Colorado, where new cases and hospitalizations are causing a health care crunch. That will affect western Kansas, not only as the virus spreads across state lines, but also as Kansans who depend on large hospitals in Denver for high-level care find it more difficult to get transferred there.

The Good: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. That means that each new infection only causes one additional infection, which means the pandemic would stay stable right at the level it's currently at. But we're still currently at a relatively high level of spread in Kansas (almost 10 times higher than we were in early June, before the Delta surge). So this is not where we want to level off.

The Bad: Total COVID hospitalizations statewide have stagnated, falling only from 461 to 454 this week, according to the Kansas Hospital Association. As of Oct. 28, hospitals in the Kansas City area remained pretty much right at 20% ICU availability, which is manageable but not much of a cushion. Hospitals in the Wichita area are still over their normal ICU capacity, but the good news is COVID hospitalizations there fell from 150 to 133 and cases in ICU fell from 62 to 50 this week. 

The Ugly: Test positivity rose from 30.3% to 33.2% this week, according to Johns Hopkins. Very high and getting higher. Only Idaho, Iowa and Oklahoma are worse. 

Kansas COVID-19 Update, Week 65

There are some concerning signs in the data this week. Overall COVID-19 hospitalizations statewide continue to fall slowly, according to the Kansas Hospital Association. But that's not the case everywhere in the state, and new infections statewide actually rose this week for the first time in more than a month. This is roughly the time of year when last year's horrendous seasonal surge began. If we're starting that again it's going to get bad fast, because we're starting from a higher rate of spread this year. 

The Good: Total COVID hospitalizations statewide fell from right around 500 to 461 this week, according to the hospital association. But COVID hospitalizations in the Wichita area actually rose from 148 to 150 (and COVID cases in ICU there rose from 55 to 62). ICU availability in the Kansas City area continues to hover right around 20%, which isn't bad, but is about as low as we want to see it go, especially if we're about to experience another surge.

The Bad: The infection reproduction rate, Rt, rose from 0.88 to 1.1 this week. It makes sense that it went above 1.0, given that new cases are increasing slightly. But that's a pretty dramatic and disheartening increase.

The Ugly: Test positivity was already bad, and this week it got a little bit worse, going from 29.5% to 30.3% according to Johns Hopkins (again, only Idaho, Oklahoma and Iowa wee higher). If test positivity had gone down, I might think the slight increase in new cases was only due to increased testing. But when new cases AND test positivity are both going up at the same time, you can be fairly certain that the pace of infections is actually increasing. 

Kansas COVID-19 Update, Week 64

We're still moving in the right direction. New COVID cases and hospitalizations continue to trend downward in Kansas, though slowly. The key question is what will happen in November/December.  Last year those months were a nightmare. But last year we didn't have a serious July/August surge like we did this year. So how much of these waves are seasonal, and how much are they driven instead by the timing of when new variants reach your region? We just don't know. But I'd feel a lot better if we had 90% or more of our eligible folks vaccinated by the time winter arrives.

The Good: The infection reproduction rate, Rt, fell from 0.93 to 0.88 this week. Dipping below 0.9 is a great step and should accelerate the downturn in new cases. 

The Neutral: Hospitalizations from COVID continue to fall and are now just below 500 statewide, according to the Kansas Hospital Association. They were well above 700 at the height of the Delta surge, so this is much better. But ICU capacity remains a bit strained, because it appears non-COVID hospitalizations have increased. Wichita's ICUs remain over normal capacity, though COVID hospitalizations fell from 157 to 148 and cases in ICU fell from 63 to 55. Would be nice to see those numbers go down faster. The Kansas City area's ICUs had about 18% availability as of Oct. 14, which was slightly less than last week's 20%, but there too the percentage of beds taken up by COVID patients seems to have gone down. It could be that hospitals are once again playing catch up in treating serious non-COVID health issues, and flu season hasn't even really started yet. It's a good time to get your flu shot.

The Ugly: Test positivity fell this week, but only from 31.6% to 29.5%, according to Johns Hopkins. That's fourth-worst behind Idaho, Oklahoma and Iowa. 

Kansas COVID-19 Update, Week 63

Our Delta wave nightmare continues to dissipate. New cases in Kansas are down to their lowest level since late July, and the downturn is slowly but surely opening up more hospital beds, especially in the Kansas City area. 

The Good: Total COVID-19 hospitalizations in Kansas are down from about 600 last week to 556 this week. ICU availability is right at 20% in the Kansas City area, which is about the minimum cushion we want to see. Wichita's ICUs are still overcapacity and operating on surge plans, but the trends are good there too — COVID hospitalizations are down from 187 to 157 and COVID patients in ICU are down from 73 to 63. 

The Neutral: The infection reproduction rate, Rt, remained at 0.93 for the second week in a row. This bolsters my suspicion that the brief drop to 0.85 two weeks ago was some sort of data fluke. The Rt seems to be pretty steady at 0.93 in Kansas. It would be nice if it were lower, but that's still low enough for cases to continue declining.

The Ugly: Test positivity rose from 28.3% to 31.6% this week, according to Johns Hopkins. That's fourth-worst in the country behind Idaho, Oklahoma and Iowa. It's a bit disconcerting that this number is going up, because it degrades some confidence in the new case numbers. We're certainly missing some infections, but I don't think it's enough to change the overall trajectory.

Bonus: There is much discussion about whether immunity from prior infection is as good or better than immunity from vaccination. The evidence we have now suggests that immunity from prior infection is highly variable - if you recovered from a severe infection, you probably have just as much protection as a vaccinated person, at least in the short term. If you had a mild case, you probably don't. And the best possible protection comes from a combination of both prior infection AND vaccination. That means there's no reason to turn down the vaccine just because you've already had COVID, given the safety profiles of these vaccines. 

To see a breakdown of the antibodies produced by four different COVID vaccines, compared to those produced by prior infection, click on the "Full text" tab of this study, and look at Figure 1. The green dots are Pfizer, the purple dots are Moderna, the orange dots are AstraZeneca (which is not currently available in the USA) and the blue dots are Johnson & Johnson. The gray dots are antibody levels from prior infection (convalescent). The gray dots (prior infection) are all up and down the antibody scale — some very high and some very low. Whereas, after two shots of the Pfizer or Moderna vaccine, the green and purple dots are much more clumped together, and clumped together at a higher level than most of the gray dots. And that's even without the third-shot boosters that are now rolling out, which dramatically increased antibody levels in trials. The other two vaccines are a different story. Based on this study (which, it should be noted, has not yet been peer-reviewed), one could make a good argument that prior infection usually provides protection that's equal to or better than the AstraZeneca or Johnson & Johnson shots. But the two mRNA vaccines (Pfizer and Moderna), which make up the vast majority of COVID shots given in the USA, provide better protection than almost any prior infection.  

Kansas COVID-19 Update, Week 62

New cases continue to fall, especially in the Kansas City area. In Kansas as a whole, the average number of daily cases for the 14 days leading up to Sept. 28 was down 22% from the two weeks before that. We're clearly on the downslope of the Delta wave, although we're still absorbing a relatively  large number of deaths from that wave.

The Good: Hospital ICU capacity continues to improve. About 17% of ICU beds on the Kansas side of the KC metro were available this week (up from 11% the week before). Wichita ICUs were still overcapacity but ICU beds taken up by COVID patients fell (from 79 to 73) for the first time in a month.   Total COVID hospitalizations statewide have fallen to 600 after several weeks above 700. To be clear, these numbers themselves are not "good." But the trend is. 

The Bad: The infection reproduction rate, Rt, rose from 0.85 to 0.93 this week. If that's accurate, that's a bad trend. But I wonder if there was a data fluke last week. Two weeks ago the Rt was also 0.93, and when it fell to 0.85, that seems like a pretty dramatic decline to me. If last week's figure was wrong, then the Rt has basically stayed the same, which is not great, but it's tolerable because it's below 1.0.

The Ugly: Test positivity rose from 27.9% to 28.3% this week, according to Johns Hopkins. Obviously it's not a big increase, but it's already a high number — sixth-highest in the country behind Idaho, Iowa, South Dakota, Alabama and Oklahoma. Those are obviously all states with large rural spaces (as is Kansas) where it might be tough to find testing unless you're already in the hospital, where you're more likely to test positive. 

Bonus: School is in session, and obviously there's a lot of questions about whether kids who are eligible (currently those 12 and up, with those 5-11 still probably a month away from eligibility) should get vaccinated against COVID. Some parents may be afraid of their kids contracting myocarditis from the vaccine. Myocarditis, or inflammation of the heart, is a known side effect of the mRNA (Moderna and Pfizer) shots. While it's usually recoverable and not serious, it's understandably scary. Here's what you need to know: the odds of getting myocarditis from COVID-19 is much greater than the odds of getting it from the vaccine. At the highest estimate, vaccine-induced myocarditis happens about 0.0047% of the time (47 cases for every 1 million second doses). Meanwhile, myocarditis occurs in about 0.146% cases of COVID. Or about 30x more often.

Double bonus: I have started a Facebook group for pro-vaccine Kansans to organize and stay up-to-date on anti-vaccine lobbying in Topeka. It is a public group, so feel free to join and invite your friends.

Kansas COVID-19 Update, Week 61

 The news is good this week. We seem to be on a steady decline of new COVID cases, both statewide and in the KC area. The decline is not as fast as the Delta upswing was, but if we can sustain it, we should be in good shape in about a month. 

The Good: The infection reproduction rate, Rt, fell from 0.93 to 0.85 this week. Every infection is causing less than one new infection, which is how we choke the virus into submission. 

The Bad: Hospital ICU capacity, while not as dire as it was a couple weeks ago, remains stubbornly tight. Only 14% of ICU beds were available in the Kansas City area this week (16% on the Missouri side and 11% on the Kansas side). Wichita's ICUs are still overcapacity, and they're one COVID patient higher this week (up from 78 to 79). It's going to be several more weeks before Wichita is at a comfortable ICU level. Total COVID hospitalizations fell there for the first time in almost three months, but only from 206 to 196. Ninety percent of Sedgwick County's COVID hospitalizations are in unvaccinated patients. Logically, that means there would be about 175 fewer people in hospital beds if everybody had gotten their COVID shots. That would certainly help.

The Ugly: Test positivity only fell from 29.4% to 27.9% this week, according to Johns Hopkins. Right direction, but still way too high and not going down fast enough. It's fifth-worst in the country, behind Alabama, Idaho, Iowa and Florida. 

Bonus: Kansas' premier anti-vaccine group held its annual rally/fundraiser last week. Read more disturbing details here. 

Kansas COVID-19 Update, Week 60

A couple weeks of declining new cases is finally taking a bit of pressure off eastern Kansas hospitals, and none too soon. Burned out respiratory therapists at the University of Kansas Hospital, overworked and tired of seeing so much death, quit en masse during the past couple weeks. That's the state's largest hospital, and traditionally one that would take critical care patients from smaller facilities throughout most of the state. But they haven't been able to accept transfers from other hospitals for over a week now, causing doctors in places like Abilene to fear their patients might die unnecessarily for lack of transfer options. If we can sustain recent reductions in new COVID hospitalizations and ICU admissions, maybe we can open enough critical care beds to avoid that. But there is a danger sign: the steady decline in new cases that we had been seeing in the Kansas City region since mid-August has reversed itself in the last couple days. This could represent a back-to-school spike. Let's hope it does not last.

The Good: The infection reproduction rate, Rt, fell from 1.0 to 0.93 statewide. That's consistent with the decrease in new cases and hopefully a number that continues to fall.

The Bad: Hospital ICU capacity statewide was at 21% availability as of Sept. 15, according to KDHE. That's not great, but better than we have been. Total COVID hospitalizations statewide (693) fell below 700 for the first time in a month, so that's good. But the state's biggest hospitals remain under some strain. Hospitals on the Kansas side of the KC metro were at about 12% ICU availability at the end of this week. That's obviously better than last week (when it was down to 1.2%), but still not where we want to be. Meanwhile, total COVID patients in Wichita's hospitals rose from 197 to 206 this week and COVID patients in ICU there rose from 73 to 78. That's a slower rate of increase than the week before, but any increase there right now is damaging. Both major hospitals are above their official ICU capacity and are operating on contingency, or "surge," plans. 

The Ugly: Test positivity fell from 31.5% to 29.4% this week, according to Johns Hopkins. It's good that it went down, but that's a pretty paltry decrease, especially when it's already so high. Kansas is fifth-worst in the country in this metric, behind Idaho, Iowa, Mississippi and Oklahoma.

 

Kansas COVID-19 Update, Week 59

Took last week off while camping for the holiday weekend. Here's the state of play: Our hospitals are jammed, they're about as overworked as they've ever been since the start of the pandemic. The good news is that new cases seem to have leveled off (and are even trending down in KC), but it will be at least another week or two before that translates into any relief for hospital workers. Right now, anyone who needs critical care in Kansas for any reason, COVID or not, is in danger of having that care compromised. 

The Good: The infection reproduction rate, Rt, is down to 1.0 statewide. Two weeks ago it was clocking in at 1.3, but I had doubts about the accuracy of that figure. Considering new cases have stabilized, 1.0 seems more indicative of where we really are.

The Bad: Test positivity was 31.5% this week, according to Johns Hopkins. That's actually down from 34.4% two weeks ago, but still way too high, and it makes it hard to know just how many new cases we're missing. Only Idaho and Iowa are higher. 

The Ugly: The Kansas Hospital Association is still graying out data on hospital ICU capacity statewide, but what's available from the state's two big medical hubs isn't encouraging. Wichita's hospitals are still over their normal capacity, and the number of COVID patients in ICUs there (73) is the highest it's been since Dec. 21 (and not far off the all-time record of 88). Kansas City's situation is also quite concerning. The metro's 27 hospitals were down to about 6.5% ICU capacity on Sept. 10, and the previous trend of things being worse on the Missouri side of the state line has now reversed as the outbreak moves steadily westward. ICUs on the Missouri side were just short of 11% capacity, while ICUs on the Kansas side were down to 1.2%. That's not a typo. There were a total of three ICU beds available on the entire Kansas side of the metro. Can't keep that up, obviously. 

Bonus: I don't know what could possibly be said at this point to convince vaccine-resistant folks to change their minds. You would think the fact that 90% of COVID patients in the hospital are unvaccinated would do it. But I know there are still some people who have real concerns about the safety of the vaccines and even believe they might be more risky than the actual disease, even though all data points the opposite direction (at least for everybody 16 and up). If you know somebody like that, perhaps this one story out of an Iowa prison will help:

Back in April, 77 inmates at the prison were shot up with six times the recommended dosage of the Pfizer vaccine due to a medical error (prison health care is notoriously bad in most states, but that's a whole other story). The nurses who made the error were fired, but the more interesting thing is what happened to those prisoners next: nothing. Some of them felt mildly ill, just like some people who get the recommended vaccine dose. Others felt fine. None had to be hospitalized. None had residual health problems. Think about that: 77 prisoners — a group that is significantly less healthy, statistically, than the U.S. population at large — got SIX TIMES the vaccine dose everyone else gets AND THEY WERE TOTALLY FINE! How in the world would that be possible if there were any real, systemic danger from the vaccine?  

Oh and, by the way, masks work. A huge, well-constructed study by a group of U.S. academics in Bangladesh confirms it. Surgical masks in particular, work well to reduce COVID transmission. Which makes sense, given that surgeons have been wearing them for decades to protect their patients from airborne pathogens.  

     

Kansas COVID-19 Update, Week 58

It's a rough time in Kansas City's hospitals. Our ICUs hit a new record for COVID-19 patients this week, 224. That's even more than during the winter surge. Exhausting. The good news is that new hospital admissions for COVID appear to be slowing. It will take time for that to provide relief, however, because COVID hospitalizations tend to last awhile. Other data this week is kind of hard to parse.

The Good: Test positivity fell from 38.8% to 34.4%, according to Johns Hopkins. That's obviously still too high (fourth-highest in the country behind Oklahoma, Iowa and Idaho) but at least moving in the right direction. 

The (maybe) Bad: The infection reproduction rate, Rt, rose from 1.0 to 1.3 this week... maybe. That's according to the Rt website I've been using, and I want to be consistent with my data sources, but I have my doubts about that number, because new cases in Kansas seem to have leveled off since hitting a high of about 1,600 on Aug. 16. If the Rt were really 1.3, we would expect new cases to be rising fairly steadily.  Another Rt calculating website has Kansas at 0.94, which seems more indicative of what new cases are doing. If Rt is really 1.3 (or even close to 1.3) that is obviously bad. If it's actually 0.94, that's mildly good.

The Ugly: Statewide ICU capacity numbers are a little hard to come by this week because the Kansas Hospital Association has blacked them out with a message that says "Reporting is paused on these elements to allow hospitals to review their data submissions." I don't know what that's about. The good news is that total COVID hospitalizations statewide only rose from 728 to 731 this week. The bad news is, that's still pretty high. Wichita's major hospitals are both still at ICU capacity and their COVID hospitalizations rose from 147 to 177.  Topeka's COVID hospitalizations have leveled off at about 74 or 75, which is high for them, but fortunately not still rising. As mentioned earlier, Kansas City's hospitals are in a bad spot, especially on the Missouri side of the state line. The metro's Kansas hospitals had about 21% of their ICU beds available as of Aug. 25, but its Missouri hospitals were down to about 11%, which is pretty dire. On the Missouri side, fully 41% of all ICU beds were being used by COVID patients, which is truly staggering for a single diagnosis. Hopefully this is the worst it's going to get for our hospitals.

Bonus: I penned this op-ed for the Kansas City Star. 

Kansas COVID-19 Update, Week 57

I skipped last week's blog because I was on vacation and, honestly, I needed a mental break from this stuff. Here's what you need to know this week: things are bad in Kansas, hospitals are pretty full in several key parts of the state, but there are indications that things could get better soon. After a month of rapid rise, new infections in the Kansas City area are starting to level off. They're leveling off at the second-highest level they've ever been, which is obviously bad, but at least they're not rising any more. The end of the rapid rise coincides with the reinstatement of mask orders. My guess is that masks have something to do with it, but don't entirely explain the change in trajectory. Rather, the mask orders themselves are a clear signal to the public to change behavior again: to reduce movement and public mixing, to keep their distance from people not in their "bubble" and, yes, to wear a mask in indoor public places. All of those, together, likely helped stem the tide. In any case, the leveling off of new cases means that if we can hold on a week or two, our hospitals may get some relief. But the beginning of school is a major wildcard in all of this.

The Good: The infection reproduction rate, Rt, fell from 1.3 to 1.0 over the past two weeks. That's consistent with new cases leveling off. Missouri's Rt is below 1 now (0.94) which could mean they're finally on the back end of the Delta variant wave, which has been just devastating there. We're a couple weeks behind them in Kansas, but we have a slightly higher vaccination rate, so maybe our wave will end up being less extreme.

The Bad: Hospital ICU capacity statewide rose from 22% to 24% over the past two weeks, according to the Kansas Hospital Association, but things were still fairly dire in Kansas' largest metro areas. The Kansas City area and southeast Kansas were down to 19% capacity, northeast Kansas (including Topeka) was down to 15%, and south-central Kansas (including Wichita) was down to 16%. Sedgwick County's ICUs hit their normal capacity on Aug. 9 and have been operating on "surge" plans since then.  In fact, according to the governor, six of the state's largest hospitals are now at their regular ICU capacity. Lots of health workers in this state need a break. Our total COVID-19 hospitalizations are still increasing at a rate of around 100 per week (up to 728 this week versus 526 two weeks ago). It's good that that rate is no longer accelerating, but we need to see it go down.

The Ugly: Test positivity rose from 21.8% to 38.8% in the past two weeks, according to Johns Hopkins. You may recall that I had doubts about the accuracy of that 21.8% figure, though, because it was such a steep drop from the week below. Take that week out, and it's up to 38.8% from 33.7% three weeks ago, which seems more likely than wild swings week-to-week. Either way, still not good. I do wonder, though, if the rise of at-home tests is making it harder to get a good handle on test positivity. People who test negative at home are unlikely to report that to their health care provider, while those who test positive will probably seek out a publicly recorded test in order to confirm the positive. 

Kansas COVID-19 Update, Week 56

Well, the badness that I had feared was coming last week has come this week instead. With the exception of test positivity, all of the trends are going the wrong direction. Delta-variant COVID is moving like a wave from Missouri and Oklahoma into Kansas, and hospitals in Kansas City and Wichita are already feeling it. I'm still hopeful that we will eventually see a steep drop in new infections, like India and the UK did after their Delta surges. But in those countries the drop didn't start until after about two months of rising infections. The Delta variant first started showing up in KC wastewater in late June (which is, not coincidentally, when the current surge started).  That means we could have several more weeks of rising infections ahead of us, and maybe another month of rising hospitalizations (because hospitalizations lag infections). That's daunting.

The Good: Test positivity fell from 33.7% to 21.8%, according to Johns Hopkins. That's a significant drop, and makes me suspicious it might be some sort of data error. The only other explanation I can think of is that more non-symptomatic people are getting tested now before they start school/college, but it seems a bit early for that. For whatever reason, we definitely are testing more now. According to Hopkins, Kansas is reporting more than twice as many average daily tests (almost 150 per 100,000 people) than we were on July 27 (68 per 100,000). 

The Bad: The infection reproduction rate, Rt, rose from 1.2 to 1.3 this week. Cases are not only continuing to grow, but they're growing faster now. However, if the test positivity numbers are right, part of the reason for the increase might be that we're identifying more infections than we were before because we're testing more. 

The Ugly: Hospital ICU capacity went from 25% to 22% statewide this week, according to the Kansas Hospital Association. A deeper dive into the data shows real danger zones. In the medical hubs of Wichita and Kansas City, ICU capacity was down to 16% and 17%, respectively, this week. The state's largest hospitals are already feeling crunched. If you look at the MARC website you can see that the problem is more acute on the Missouri side of the KC metro. On Wednesday (the most recent day that all of the area hospitals reported their data), the 10 facilities on the Kansas side had about 21% of their ICU beds available, with 20% taken up by COVID patients. The 17 facilities on the Missouri side had about 11% of ICU beds available with 35% occupied by COVID patients. The wave is moving westward from central Missouri and has already basically smothered the KCMO hospitals. The ripple effect is now moving through the KCK and Johnson County facilities. COVID patients in Kansas hospitals rose from 415 to 526 this week, an increase that was more than double that of the week before. 

Bonus: This video from a doctor in New Orleans (which is also being hit hard by Delta) is worth watching. If your hospitals are full, it's bad for everybody, vaccinated or not. 

Kansas COVID-19 Update, Week 55

The rate of new cases in the Kansas City metro area is now higher than it ever was last summer (though still not nearly as high as during the nightmarish fall/winter surge). Given the transmissibility of the Delta variant, it seems destined to just keep rocketing up, right? Maybe, but something interesting has happened with Delta in England. After about a month or two of extreme surge, new cases there have dropped rapidly in the last two weeks. England has a slightly higher vaccination rate than the U.S., and much higher rate of masking (95% of people there are doing it, according to one survey), so it's not a perfect comparison. But cases have also declined rapidly in India after Delta ravaged that country. It could be that Delta spreads so fast that it essentially burns itself out, running through a population and infecting all the easy "marks" (people who have no immunity from vaccine or prior infection, aren't masking and are in close contact with others who aren't masking), and then finding itself fenced in. It's just a theory, and not anything to bank on, but based on the evidence from overseas, it does seem like Delta fades just as dramatically as it surges. And the metrics in Kansas this week are not nearly as bad as I feared they would be. 

The Good: Hospital ICU capacity statewide rose from 23% to 25%, according to the Kansas Hospital Association. The KC metro area was up from 17% to 21% and Wichita region was up from 19% to 20%. The only area of real concern was northeast Kansas (which I assume means everything other than KC — such as Lawrence, Topeka and maybe Leavenworth). There, ICU capacity was down to 15%. That's something to keep an eye on. Overall COVID hospitalizations statewide rose from 366 to 415, but I still take that as sort of a good sign. That's an increase of about 50 patients in a week, whereas the previous week we saw an increase of about 95. So the pace of new hospitalizations may be slowing, even if total hospitalizations are still rising.  

The Bad: The infection reproduction rate, Rt, in Kansas stayed at 1.2 this week. That means cases are still rising, but they aren't rising at a faster rate than they were the week before. I would love to see this number go down. As we all know by now, below 1.0 is where we want to be. 

The Ugly: Test positivity rose from 31% to 33.7%, according to Johns Hopkins. That's fourth-worst in the country behind Oklahoma, Mississippi and Alabama. It's not a huge increase, but it was pretty high to begin with.

Bonus: I have seen a disconcerting number of people on social media asserting that the vaccines "don't work" since the CDC issued its new guidance on masks. It's just not true, and if you want some evidence, look to Vermont. I have been checking the state health department's COVID-19 dashboard there regularly, because it's our most fully vaccinated state at nearly 70% of all residents (that's not just ELIGIBLE residents, that's everybody, including the kids who are too young to get the shot). The Delta variant has been present in Vermont since at least early June, but it has not had nearly the devastating effect there that it has had in Missouri. In fact, it's had almost no effect at all. Cases are up a bit, but hospitalizations have barely budged, fluctuating from about 3-5 people at any given time (yes, Vermont is a small state, but having only a few hospital beds in the ENTIRE STATE taken up by COVID patients is still amazing). And, get this: there has not been a single COVID death in Vermont for the last three weeks. Vaccines work. Even against the Delta variant, Vermont's high vaccination rate has succeeded in turning COVID, a disease that killed more than 500,000 Americans in a single year, into something akin to a common cold or flu. 

Kansas COVID-19 Update, Week 54

Everything looks worse this week, both statewide and in the Kansas City area specifically. The outbreak that incubated in Springfield has now fully moved here. Cases are up, hospitalizations are up, and even deaths are beginning to tick up again. KU Hospital, the biggest in the state, is feeling the pinch of capacity issues already. Our vaccination rate in KC is about 10 percentage points higher than Springfield, so we should expect our surge to plateau more quickly and at a lower level. But things still seem perilous right now. A couple months back I thought the danger of overwhelmed hospitals was past. But the Delta variant and the extreme slowdown in vaccinations have changed that.

The Bad: The least bad thing this week is the infection reproduction rate, Rt, which only went up from 1.1 to 1.2. Still not good, but at least it's not rising faster. The current outbreak will not plateau until we get the Rt down to 1.0. The most effective way to lower it is through vaccinations. After that, it's wearing masks and staying away from other people as much as possible. 

The Worse: As I sit down to write this, the KDHE dashboard for COVID-19 data seems to be down. Fortunately, the Kansas Hospital Association has updated its dashboard this week, for the first time in over a month. Hopefully there will be more updates to come, because these are numbers Kansans need to know. Adult ICU capacity is down to 23% statewide this week. Can't compare that to last week's 35% number, because that came from KDHE (which I believe also includes pediatric ICU beds). But here's a number we can compare: Total COVID hospitalizations statewide rose from 270 to 366 this week. ICU capacity is most strained in the Kansas City area (17% availability) and Wichita area (19%). That's bad because that's where the vast majority of ICU beds in the state are. Kansas City hospitals haven't seen this many COVID patients since last fall's surge. Obviously, Delta moves through a community very fast. Other regions should take note. 

The Ugly: Test positivity, as calculated by Johns Hopkins, rose from 26.5% to 31%. There's probably a lot more viral transmission out there than we're finding through testing right now, which would explain why hospitalizations are rising so quickly.  

Kansas COVID-19 Update, Week 53

Our months-long reprieve is over. New cases are still going up, and now hospitalizations are too. Missouri's COVID outbreak has come to Kansas, both directly (the surge in infections spilling over from southwest Missouri to southeast Kansas) and indirectly (the ripple effect of full hospitals sending patients to Kansas City). Our hospital capacity statewide is still in good shape, but the vaccination rate in Kansas is only nominally better than in Missouri. It's quite possible that some under-vaccinated areas of Kansas will be clobbered just as badly as Springfield, Mo., is now. The excellent science journalist Ed Yong recently wrote this piece about what it's like there. I recommend reading the whole thing, but this quote, from the medical director of CoxHealth, is perhaps the most important part for people who live in the KC area, where hospitalizations are up:  “Now we’re blasting (patients) outward,” Coulter said. “We’re already saturating the surrounding hospitals.”

The Good: The infection reproduction rate, or Rt, remained at 1.1. That qualifies as good news this week. It means that active cases are still rising, but they're not rising any faster than the week before. Of course, that depends on us testing enough to actually know how many cases there are. Which isn't happening. 

The Bad: Hospital ICU capacity fell from 37% to 35% this week, according to KDHE. But the really bad part is what's lurking behind those numbers. Total COVID hospitalizations rose from 143 on July 7 to 270 by July 14. Yes, that's almost double. We don't know yet how many of those people will eventually need ICU-level care, but certainly a chunk of them will. And cases in ICU are already up from 51 last week to 73 this week. Not good.

The Ugly: The precipitous rise in hospitalizations likely signals that we're missing a lot of cases at the pre-hospitalization phase, when they're pre-symptomatic or showing only mild symptoms. Because we're not testing enough. Test positivity rose from 23.8% to 26.5% this week, according to Johns Hopkins. That's going from bad to worse.

Bonus: The CDC warned this week that the COVID-19 vaccines are unlikely to work as well for people who are immunocompromised because of medical conditions or medications. This is logical, and the real-world data to back it up has been building for months now, but the CDC has been typically deliberate about making any definitive statements about it (which is not necessarily a bad thing — good science is often slow). What this means is that vaccination is not just a personal choice. If you choose not to be vaccinated, you're putting at risk people who are in cancer treatments, or have had organ transplants, even if they personally made a different choice. We need each other to beat the virus. Immunocompromised people are relying on the rest of us to get vaccinated, because it makes us far less likely to pass the virus to them. If you won't get vaccinated for your own benefit, please, PLEASE, consider doing it as a favor to your immunocompromised neighbors.     

Kansas COVID-19 Update, Week 52

 

COVID-19 continues to rage through Missouri, particularly in the southwest part of the state, where hospitals may be only a couple weeks away from having to turn away patients. New cases are clearly on the upswing in Kansas now as well. But we are not yet seeing a marked increase in hospitalizations. 

The Good: Hospital ICU capacity improved from 35% to 37% this week, according to KDHE. There were 143 total COVID hospitalizations as of July 7, including 51 in ICU. That's roughly in line with last week's numbers. 

The Bad: The infection reproduction rate, Rt, has risen from 1.0 to 1.1 this week. This was pretty much inevitable, given the rise in diagnosed cases. If the number of new cases is rising, then Rt will rise as well. The Rt rates in nearby states (1.3 in Oklahoma and Nebraska, 1.2 in Arkansas and Missouri) are also concerning. 

The Ugly: The test positivity rate in Kansas, as measured by Johns Hopkins, rocketed up again from 16.8% to 23.8% this week. That's the second straight dramatic increase and it means that even though we know that new cases are rising, we don't even have a good handle on how fast they're rising.   There have been anecdotal reports in the news about symptomatic people declining to be tested for COVID. That means a bigger share of the people who ARE being tested would be those who are hospitalized, which would obviously drive up test positivity rates. Declining to be tested if you have symptoms or know you've been exposed is not only bad for your own treatment plan, it's also grossly irresponsible to your family, friends and neighbors.

Kansas COVID-19 Update, Week 51

Hospitals generally see more burn victims on the 4th of July weekend. This year they're also seeing more COVID patients in Kansas. After several months of decline, new cases are now rising slowly, and so are hospitalizations and ICU admissions.

The Good: Hospital ICU capacity was 35% in Kansas as of the last day of June, according to KDHE. That's less than last week (37%), but still qualifies as the best news of the week. COVID-related hospitalizations are now hovering in the 140-150 range, after being in the 110-120 range in early June. And cases needing ICU are also beginning to rise, from down in the 30s in early June to the 50s now.    

The Bad: The infection reproduction rate, Rt, is now estimated at 1.0. That's the magic number at which active cases start going up again.

The Ugly: Test positivity jumped from 10.6% to 16.8%, according to Johns Hopkins. That's a substantial increase that once again makes Kansas the worst state in the country in this measure. Let's hope it's a data error. 

Bonus: COVID continues to rage in rural Missouri, and the effects are now being felt in Kansas City. Several area hospitals are now treating more COVID patients. They have the beds to handle it right now, but the rural hospitals that are sending them those patients are increasingly stressed, according to this doctor from KU Hospital:

 

Cases are going up in my hospital. Rural counties that send us patients have full hospitals with more than 90% of their cases Delta variant. I know it’s been a long time. I wish this was over, too. It’s not. :(

— Carla Keirns (@CarlaKeirns) July 4, 2021

 This will only get worse if current trends hold. 

Kansas COVID-19 Update, Week 50

Cases are still decreasing slightly in Kansas, but they're now rising in nearly all the surrounding states, including Missouri, which is now recording new case levels not seen since February. That will eventually have a spillover effect here. In fact, some border counties are already seeing slight increases, including Johnson County, which has more vaccine protection than most. The Delta variant is here, and those who are unvaccinated will be vulnerable.

The Good: The infection reproduction rate, Rt, dropped from 0.96 to 0.94. Always have to take this number with a grain of salt, because we've never done adequate testing. But it's good when Rt goes down. Here's the concerning part: look at this map. Missouri, Arkansas, Oklahoma and Nebraska all now have an Rt above 1.0, which means cases are increasing there. That's trouble for Kansas, especially during the summer travel season. 

The Bad: Hospital capacity fell a bit, from 39% to 37% this week, according to KDHE. That is still enough, but the number of patients hospitalized with COVID continues to climb, albeit slowly. The number in ICU does not seem to be rising proportionately lately, though, which is a good sign. Fewer infections are resulting in life-threatening illness.

The Ugly: Test positivity remained at 10.6%, according to Johns Hopkins. That's fourth-worst in the country, behind Arkansas, Idaho and Oklahoma (Missouri was fifth at 10.2%).

Bonus: An Associated Press analysis of data found that in May only about 1,200 of the country's 853,000 people hospitalized with COVID had been fully vaccinated (that's roughly 0.1%). Only 150 of the 18,000 Americans who died of COVID had been fully vaccinated (that's less than 1%). Hard to know for sure, but it's possible that all or nearly all of those 150 people were taking medications or had underlying medical conditions that made their immune systems less likely to mount a robust response to the vaccine. The vaccines are not foolproof, but they are nearly foolproof. Nearly everyone who is being hospitalized or dying from COVID right now is unvaccinated. That's it. That's the bottom line.  

Kansas COVID-19 Update, Week 49

It's a bit of an odd time in Kansas, as far as COVID goes. We seem to be pretty stable at about 100 new cases per day, which is manageable, but not ideal (ideal would obviously be moving toward zero at this point, like Vermont, where more than 80% of ALL residents are now vaccinated, and there are only TWO people hospitalized with COVID in the entire state). But test positivity is still high here, so we might be missing some cases, and  COVID hospitalizations have risen a bit of late. And then there's Missouri, which is looking more concerning by the day.

The Good: The infection reproduction rate, Rt, fell from 0.97 to 0.96 this week. That's good, but needs to be taken with a grain of salt, given the deficiencies in testing. A one-hundredth of a point difference could just be a function of undiagnosed cases.

The Bad: The Kansas Hospital Association didn't update its COVID dashboard this week, so I'll have to pull hospital data from KDHE. That data shows 39% ICU capacity available statewide, which is good. But it also shows slight increases (roughly 15%) in both COVID-related hospitalizations and ICU admissions last week. Not a good trend. Confirmed cases aren't going up, but hospitalizations are, which either means we're missing some cases, or the cases that are occurring now are more severe, and therefore more likely to require hospitalization (which could be the case if, as speculated, the new Delta variant that's now circulating causes a rougher form of the illness).

The Ugly: Test positivity fell from 11.2% to 10.6%, according to Johns Hopkins. But it went down more in other states. In fact, Kansas now has the highest rate in the country, at least as Johns Hopkins calculates it (some folks on social media have pointed out that the way that Hopkins calculates test positivity tends to result in a significantly higher rate than the way that state and local governments in Kansas calculate it. This is true. But it's still useful for comparing one state to another, and right now Kansas doesn't compare well). 

Bonus: Missouri is increasingly looking like a problem. Rural counties with low vaccination rates are encountering the Delta variant (and others) and the result is that new cases were up about 10% statewide last week, even as they kept plunging in metro areas like KC. The discrepancy here is not complicated: it's about vaccination rates. All things being equal, urban counties with much greater population density should be more susceptible to outbreaks than rural counties. But what we're seeing is the exact opposite. And that's because most urban and suburban counties have so far vaccinated a higher percentage of their residents. Unfortunately, the virus doesn't respect county lines, so the outbreaks happening in Missouri's low-vaccination areas are likely to spread, especially as we get into the heart of the summer travel season.