Vaccines (and vaccine requirements) save lives

Photo by Mufid Majnun on Unsplash

Incoming Minnesota state legislator Walter Hudson recently said at a public event that people who support vaccine requirements are equivalent to "slave holders." The event was ostensibly about COVID-19 specifically (hosted by "Mask Off MN" - which is a weird name, because I live in MN now and outside of the doctor's office I haven't seen a single place requiring masks). But Hudson didn't seem to make any distinction between COVID vaccine requirements and requirements for other types of vaccines that have been in place for decades in schools and daycares — either in his initial remarks or when he later doubled down on his slave-holding analogy.

This is kind of important to me personally because if he's including other vaccines in his remarks, then I'm one of those people who are, in Hudson's words, "equivalent to a plantation owner who enslaved Black people and forced them to work for you." And that's sort of off-putting.

For almost 20 years I have been advocating for the meningitis vaccine to be required for school attendance, dating back to when meningitis nearly killed me and took parts of all four of my limbs. One of the first things I did when I got out of the hospital was call for the University of Kansas to require the vaccine for incoming students. Later I testified for teenage meningitis vaccine requirements at state legislatures in Kansas, Nebraska, and Missouri. I did this because I didn't know there was a vaccine for meningitis when I got sick, and after I got sick I knew all too well what can happen to you if you don't get the vaccine.

The timing for my advocacy was good. Bacterial meningitis vaccines had existed in some form since the 1970s, but the first-generation shots didn't provide long-lasting protection and as a result they really weren't required anywhere outside of military barracks and scattered colleges. Then a new type of vaccine was developed and released to the public in 2005. It provided strong, durable protection against four of the five major strains of bacterial meningitis in the U.S. (A,C,Y and W). That's when efforts really ramped up to get this new shot required for school attendance, and I played a small role in those efforts. 

Now, most states do require the "quadrivalent" meningitis shot, and the results have been pretty remarkable. By 2018, about 80% of kids were vaccinated against meningitis and far fewer were getting sick. Bacterial meningitis cases in the U.S. used to fluctuate from about 1,500 in a good year to 3,500 in a bad year (doesn't seem like a lot, but when you consider that about one in every three cases results in death or permanent injury — brain damage, hearing loss, vision loss, amputations — that's significant carnage). Since the 2005 vaccine there have been no more peaks and valleys. Cases have just dropped steadily, and now sit at about 300-400 per year. That's a 90% reduction from peak, which means that in the past 18 years, thousands of Americans have avoided death, disability and disfigurement just by getting a simple shot. That's pretty much a miracle. Of the cases that remain, about 200 a year are caused by Type B meningitis — the one type that the 2005 shot doesn't prevent. In a nutshell, one type of meningitis now causes more cases in the U.S. than all of the other types combined, because most at-risk people are now vaccinated against the other types.

Could we have gotten there without the state-by-state requirements? Maybe, but I doubt it. Here's why: while we were making great progress with the 2005 quadrivalent vaccine, a new vaccine against meningitis B was developed and released to the public in 2014. It's now widely available in most doctor's offices and pharmacies. It prevents the same awful disease as the other shot. But the uptake of the Men B vaccine has been poor — only about 20% of kids get it. Why? Lack of awareness no doubt plays a role. But it's also because, outside of a few dozen colleges nationwide (many of which have experienced a tragic Men B outbreak), the Men B shot is not required. This is partly a financial decision on the part of health policymakers: the Men B shot is new and under patent, it's relatively expensive as vaccines go, and policymakers don't believe they have enough data yet to recommend a costly mass-vaccination program for an illness that strikes only about 200 Americans a year. In fact, it's likely that the Men B-specific shot will never be required for most kids, because Pfizer is at the tail-end of clinical trials for a "pentavalent" vaccine that will combine protection against Men B with protection against the other four strains. One meningitis vaccine to rule them all, I guess you could say. 

But just as this incredible tool for possibly eliminating bacterial meningitis approaches approval, our collective will to use it seems to be waning. Since COVID, more Americans, especially those who fall on the right wing of the political spectrum, apparently believe that no vaccines should be required for school attendance — about 35%, according to a recent survey. Politicians like Hudson are tapping into that discontent with rhetoric meant to inflame emotions, rather than engender a calm discussion. 

I understand that people don't like being told what to do, especially when it comes to health care. And I would be fine with not having vaccine requirements if that still resulted in more than 90% of families voluntarily getting their shots. I'm results-oriented on this and if we can get the same or better results without any vaccine requirements, I'm all for it. But as a practical matter, we know that's not what happens. We know because studies have shown that states with weaker vaccine requirements tend to have more opt-outs and more disease outbreaks. And we know that as vaccination rates have leveled off or even fallen in recent years, diseases that we should be rid of, like measles and even polio, have come back. The practical costs of undoing vaccine requirements quite clearly outweigh the benefits, which are purely ideological. You may not like vaccine requirements, but they save lives. They're not slavery — they're freedom: freedom from disease, freedom from being tethered to a ventilator in an ICU, freedom from an early death.

Let's remember that before we make childhood vaccine requirements part of a political culture war that is already having deadly consequences.   

Some random thoughts on becoming a dad

It helps that he's crazy cute

My son, Alex, just turned three months old and I’m a full-time dad now — at least for the next eight or nine weeks while I’m on parental leave.

These first months have been a whirlwind. I think I’ve been trying, and failing, to catch up on sleep ever since those first couple nights I spent on the fold-down couch in our hospital room. There are many things about my dad that I now appreciate even more, and one of them is that he spent 140 straight nights on one of those couches when I was hospitalized with meningitis.

I would love to say that it has been all rapturous joy for me since the moment Alex was born, but that wouldn’t be true. It is quite an adjustment, this parenthood thing. Alex is, I think, a pretty easy baby overall. But it’s strange when your schedule is suddenly dictated entirely by an 8-pound human being with a strong set of lungs. Especially when you’ve spent the first 20 years of adulthood without kids, largely able to use your free time as you see fit. 

I also think the bonding process is a little different for dads than for moms, who have already gotten to know their babies in a very special way long before they’re born. For me, the first week or two after we brought him home were strange. There was a baby in my house, but I was still trying to wrap my head around the idea that he was my baby.  

That’s not to say there haven’t been times of rapturous joy. I can recall at least three times in the early days when I was actually brought to tears by Alex. One was when he was born, via c-section, in an operating room. I bawled my eyes out when they brought him from around that curtain and we saw him for the first time, all purple and screaming. I was snapping pictures like crazy and I can remember asking the nurse “Can I touch him?” and her nodding. I could tell she was grinning even though she was wearing a surgical mask. 

I also cried, though more subtly, the first time I gave him a bottle. There was something about watching him latch onto it with his mouth, something about being able to put nourishment into that tiny, hungry body, that was just overwhelming emotionally. Yet another reason I think it’s easier for moms to bond with their little ones.

The third time I can remember tearing up was when I was rocking him to sleep in our nursery. We had spent months getting that room ready, getting the glider chair in the right place and getting the shelves set up around it so everything — books, Kleenex, burp clothes, etc. — was within arms-length of the chair. The last thing we did was install a blackout curtain, just a couple days before he was born. I remember, after getting that done, telling myself, “OK, now we’re ready.” I was so naive. But when he was finally home, and I was sitting in the chair in a dark room, rocking slowly and listening to soft classical music as he fell asleep in my arms, I remember thinking “OK, this is it. Soak it up, because it doesn’t get any better than this.” And I cried. 

Here are some other miscellaneous observations from the first three months:

My wife is a hero

I knew my wife was amazing before Alex was born, but I didn’t fully appreciate how amazing. She was in labor/pre-labor for basically two days, then had a surgery in which they cut through every layer of her abdomen, and then went right into breastfeeding around the clock a few hours later. And she’s been doing it ever since, feeding him every few hours during the day, and several times a night. I don’t know how she’s doing it. She’s working on significantly less sleep than I am and she’s doing it all with a more consistent, better mood than me. I’ve been up and down emotionally. She’s been rock solid.  

I’m an old dad 

I turned 41 a couple months after Alex was born. Earlier this year I started to feel some persistent soreness in my left knee. I saw an orthopedic specialist who turned my knee in a few different directions, asked if it hurt, and then said maybe I had a partially torn meniscus. If so, he said I would need a minor outpatient procedure and I’d probably be good as new in a couple weeks. That didn’t sound so bad. 

But when the results of the MRI came back he said, “Well, it’s not a torn meniscus. You just have osteoarthritis in your knee.” There’s no procedure for that. Just ibuprofen, Voltaren, and a knee brace. This is not great when standing up and bouncing Alex for 20 minutes or so is the only way to calm him down. Maybe I should wear my knee brace more.

A few months before Alex was born I also noticed that my vision, which had been better than 20/20 most of my life, was starting to get a little fuzzy. I went to the optometrist and he confirmed it: I have age-related vision loss. I was like, “But it came on so suddenly.” And he said, “Oh yeah, that’s how it happens. You get into your 40s, and boom.” Which is a bummer, because I had always thought of my vision as kind of like my superpower, especially after I became physically disabled in other ways. Maybe there were things I couldn’t do any more, but I could still wow my friends and family by reading small print on billboards far away.  

Not any more. Now I need glasses, and that means it hurts when I’m holding Alex and he bops his face against mine inexplicably. Maybe I should look into LASIK.

My age also means it’s probably not the best time in my life to cart around a small human being who keeps getting heavier. First I noticed a knot in my upper back, near my left shoulder blade. Lately that has dissipated and been replaced by a pinch in my lower back, near my waistband. Maybe I should stretch more.

One good thing about becoming a dad later in life, though: Alex usually wakes me up at least once or twice a night, so I use those times to go pee. I was going to have to eventually anyway. 

I’m a disabled dad (and that’s OK)

When I imagined being a dad in the abstract, I wasn’t really worried about the fact that I can’t walk without leg braces and I’m missing most of my fingers. I just kind of assumed I would figure things out, much like I did when I first had my amputations. 

But then, as Rachael’s due date came closer, I started remembering exactly how much work it took to figure things out. It took months. Years even.  

Then I started to worry a little. I looked for stories about parents with disabilities who could tell me how it’s done. The best I could find was this book out of Australia, which put my mind at ease some. 

Since Alex was born, I think the most frustrating part about being a dad with disabilities is that if he’s fussy at night, I can’t just jump up out of bed, pick him up and soothe him. I can pull him out of his bedside bassinet and try to do it sitting in bed with him, but that doesn’t always work. And that doesn’t let Rachael sleep like it would if I could take him to another room. If I’m going to get up and take him to the nursery, for example, I’ve got to put my leg braces on and it’s a slow process and by the time I’m done he’s usually full-on wailing. Then everybody’s up anyway. So Rachael has taken on a lot of the overnight responsibility and I feel bad about that, but she’s a warrior and she never complains. Plus, she can feed him, which is what he usually wants anyway. 

I’ve also found that a lot of baby clothes are just not made for people with limited fine-motor skills. All those little zippers and snaps, ugh. Trying to pull a tight onesie up over his head when he’s already fussy is also an adventure. There are some baby clothes, however, that fasten with magnets sewn into the fabric. They are awesome.

Some able-bodied dads, like Bradley Cooper, say they relish every diaper change. I do not. For me, it’s a ponderous process and there have been times when Alex is screaming on the changing table and I have literally said out loud, “OK, I don’t like this either. I, too, wish this was going faster.” I will say, though, that unlike the makers of baby clothes, the makers of baby diapers seem to have tried to engineer their products to be easier to put on with one hand. Which is extremely helpful. I’ve also found that it makes things go faster if I have everything out and ready (the wipes, the Desitin, the fresh diaper), before I start the process. 

It’s still a bit of a panicky situation when he starts peeing on the wall as soon as I get the dirty diaper off him. But I’m fast becoming a diaper changing pro, especially now that I’m on leave and get to practice several times a day. 

The logistical challenges of being a disabled dad are all surmountable in one way or another, especially with a supportive partner like Rachael. I do still have some anxieties about when Alex gets older and I can’t play catch with him like the other dads, and the kids at school ask him “why do your dad’s hands look so funny?”

But we will cross that bridge when we come to it, and hopefully in a way that will make him even more sensitive and accepting of people who are different.

For now, the cool thing is that he doesn’t know that I’m different, even when he wraps his tiny fingers around what’s left of my hands. He just knows that I’m the guy who holds him, and rocks him and occasionally gives him a bottle. That’s enough to make him smile in the morning when he sees me. And that’s enough to make this whole crazy journey worthwhile.   

Kansas COVID-19 Update, Week 83

I didn't provide an update last week because I was busy with other things and, frankly, it felt right not to. I guess I need a break. I've been doing these for awhile, and things are looking good now. So this will be the last post for the foreseeable future. It's entirely possible we will have another COVID surge, especially if a new variant emerges and becomes dominant. Then I may start watching the data closely again. But for now I'll provide a last look at the numbers and then a short roadmap for moving forward under current conditions.

The Great: Test positivity has fallen to 4.6% in Kansas, according to Johns Hopkins. I can't remember the last time it was that low. Probably almost a year ago when the vaccine rollout drove case counts way down in May and June, before the Delta variant showed up. 

The Good: Hospitalizations numbers are way down.

• Statewide COVID hospitalizations fell from 503 to 237 in the last two weeks, according to the Kansas Hospital Association. If it keeps halving every two weeks we will be down to just a handful of hospitalizations by May. 

• Statewide cases in ICU fell from 94 to 43. Also roughly halving on a two-week basis.  

• COVID hospitalizations in the Wichita area fell from 98 to 47 in the last two weeks, and cases in ICU fell from 29 to 10. That's significant relief for the health care workforce.

• COVID hospitalizations in the KC area (bistate) fell from 529 to 311 and cases in ICU fell from 87 to 54. 

• Overall ICU availability in the KC area rose from about 21.5% to 25%. Regular hospital bed availability continued its trend of rising more slowly, only going from 16.2% to about 17%. We are not quite back to sustainable levels of hospital capacity yet, but we're quite close.

The Not-As-Good: The infection reproduction rate, Rt, rose to 0.82 this week. A couple months ago I would have taken 0.82 in a heartbeat. But now it comes in the context of an Rt that was as low as 0.69 just two weeks ago. What this means is that the number of overall active infections is still going down, but the decline is slower now. New cases are leveling off. Eventually we may end up with a sort of static situation where Rt is around 1.0 and the number of active infections stays relatively stable due to increased immunity (both vaccine-drive and infection-driven) in the state. Or we could continue to see the dramatic ebbs and flows we have seen for the last two years, especially if a variant with dramatic mutations that evade that immunity shows up.

Bonus: So how do we move forward from here? It would be tremendous if the Rt stayed below 1.0 in perpetuity and COVID just gradually burned itself out. But it's unlikely. What's more likely is that we end up in a stable state with seasonal fluctuations, similar to flu. We can deal with that as a society, thanks to vaccines and new treatments. In fact, in England COVID is now slightly less deadly than the flu, after being roughly 20 times more deadly at the start of the pandemic. That's due largely to increased immunity (both vaccine and infection-driven). England's vaccination rates are higher than the USA's, so I'm not sure we can say that COVID is less deadly than the flu here yet. But we've made significant progress. 

Will we need a booster every six months, or every year? The good news is that there is increasing evidence that just one Pfizer/Moderna booster provides lasting protection against severe disease for most people, even against variants. People who are immune-compromised or people who just want to maximize their chances of avoiding ANY infection (mild or severe) may want to seek out regular boosters. But other people may be content to risk mild infection, which then provides hybrid immunity and even greater levels of future protection. There are unknown wild cards there, such as the dangers of long COVID, or the danger of passing a mild breakthrough infection on to someone who is immunocompromised. I wish we had more answers about these risks.

While it's clear that vaccination is the most important thing you can do to protect yourself, the evidence for masking has only grown recently. If you have immuno-crompromised people in your life, you may want to continue masking until case rates are even lower. If case rates spike up again, everyone please mask up. And definitely, without a doubt, if you are having symptoms of upper respiratory infection, please wear a mask around other people, at least until you can get a PCR test that confirms you're COVID-negative. This is frankly something we should have been doing even before COVID, as a courtesy to others, to prevent the spread of other diseases that only transmit from symptomatic people.

For more on how we navigate toward a "new normal" when it comes to COVID, consider this op-ed by Paul Offit, one of the leading vaccination experts in the country. And heed the words of Dana Hawkinson, the top infectious disease expert at KU Med, who advises that the best protection is to stay up-to-date with vaccinations and, in high-risk situations, wear a mask.

“We have to remember that individually, now, it is really up to everybody to try and protect themselves, reduce their chance of going to the hospital,” Hawkinson said.

Thanks for reading, and be kind to each other. 

Kansas COVID-19 Update, Week 82

 

Everything continues to trend in the right direction. New cases are at their lowest level since last summer, hospitalizations are down and deaths are also leveling off (though we're still certainly going to hit 8,000 as a state soon).

The Good: Test positivity fell from 16.2% to 9.8%, according to Johns Hopkins. That still places Kansas 10th-highest in the nation, but the number continues to decline steadily. With both new cases and test positivity falling simultaneously, we can be quite certain we truly have less virus circulating among us.

The Also-Good: COVID hospitalizations continue to drop. 

• Statewide COVID hospitalizations fell from 639 to 503 this week, according to the Kansas Hospital Association. That's a slight slowdown compared to the decrease we saw last week, but still quite good. 
• Statewide cases in ICU fell from 119 to 94. This is going to drop more slowly because these patients are seriously ill.  
• COVID hospitalizations in the Wichita area fell from 137 to 98, and cases in ICU fell from 45 to 29. Both Wichita hospitals are still managing through surge ("contingency") plans, but hopefully will be able to scale back to normal operations soon. 
• COVID hospitalizations in the KC area (bistate) fell from 671 to 529 and cases in ICU fell from 114 to 87. 
• Overall ICU availability in the KC area rose from about 19.2% to 21.5%. Regular hospital bed availability only rose from about 15% to 16.2%. We are still catching up on delayed medical care, but fortunately the drop in COVID cases allows our hospitals to do so more comfortably.

The Stable: The infection reproduction rate, Rt, stayed at 0.69. Still good. 

My neighbor died of COVID

My neighbor died of COVID a couple weeks ago and I’ve been thinking about her lately. Workers have been next door removing her belongings from the house — placing some in the back of a box truck but most in a dark blue dumpster that takes up nearly all of her driveway. Soon all traces of her will be gone from the neighborhood. Then we’ll get new neighbors, I suppose.

My wife and I were not particularly close with our neighbor, but we did interact with her regularly. She was in her late-60s, with myriad health problems that made it difficult for her to get around, even on her good days. On her bad days, she was basically homebound. She had our cell phone numbers and would occasionally ask us if we were going to the store and could pick up some groceries for her. We would deliver the groceries and then spend a couple minutes just talking about the usual small stuff — weather, our dogs, if we’d be traveling for upcoming holidays. She paid us for the groceries and occasionally threw in a Starbucks gift card for our trouble.

Once the pandemic hit, these visits became even shorter. My wife and I were acutely aware of our neighbor’s vulnerability to COVID and never wanted to be the exposure that cost her her life. So we went over there masked and often just left the grocery bags on the porch. More and more, our interactions with her were only via text.

Meanwhile, her other health problems left her constantly in danger of exposure to COVID. Multiple times the fire department showed up at her house to help after she’d fallen. Sometimes an ambulance would show up and take her away for a few days. Sometimes she would drive herself to the hospital and check in. It’s a testament to the masking and infection control procedures of the first responders and hospital workers that she never got COVID during those times.  

When the vaccines were approved, she needed some coaxing to take them. My wife and I both told her we had gotten ours as soon as we were eligible, and that seemed to ease her mind somewhat. Still, she backed out of her initial vaccine appointment and had to wait a couple more weeks, which was frustrating for us. After she finally got her shot, she texted that “We are all pioneers” on a journey with these new vaccines. I considered the real pioneers the people who signed up for the clinical trials, but I could understand her perspective. 

When she got her second dose, we breathed a sigh of relief, but given her health issues, we knew the vaccine wouldn’t be a silver bullet. As the months passed, we never followed up with her about getting a booster, which I really regret now (based on conversations with some of her friends, we don’t believe she ever got it). 

When the delta/omicron surge hit and it seemed like COVID was everywhere, it happened: our neighbor checked in to the hospital with a breakthrough infection. She told us via text that she thought her home health aide had brought the virus into her house. She also told us that a friend was getting her mail and her dog was being boarded. 

That was her second day in the hospital. We asked how she was doing and she said she was on oxygen and it seemed to be helping. She was at a small satellite hospital and was awaiting transfer to a bigger facility. 

That was the last text we got from her. About a week later we learned that she had died. I don’t know if she ever got to that bigger facility. Our hospitals were absolutely slammed at that time and beds were hard to come by. Nor do I know whether it would have made any difference. She was very medically fragile.

Those “what ifs” are not what I’ve been thinking about for the past few weeks. Instead, I’ve been wondering what her last days were like. What happened in the time between when she sent us that last text and when she passed away. She would not have been allowed any visitors other than family, and her only family was a sister who lives on the East Coast and was not able to be here. It comforts me some to know that she was not truly alone — that the hospital staff was there at least.

But I still wonder what it was like. Was she sedated and put on a ventilator and just never woke up? Did she opt against “extraordinary measures” like intubation and drift away on a morphine drip? Or did it all happen too fast for that, and she died “coding” — gasping for air as medical workers rushed into her room and tried to help? Was she resigned to death, or was she fearful? How much did she suffer, physically or emotionally?

It’s impossible for me to know. The only potential clue I’ve found is that in our last text exchange she mentioned “dog’s boarded” twice. In those exact words. Once at the beginning and once at the end. 

Her only daily companion, the one creature in this world that relied on her, was safe. She wanted us to know that. I think maybe she wanted to remind herself of that too. 

For much of the last two years our national conversation around this disease has focused on disagreements over masks, school closures and vaccines. All of that is important, and Lord knows I have engaged in a lot of those conversations myself. But I also think maybe we’ve gravitated toward those discussions because it’s easier than trying to just grapple with the immense human suffering the pandemic has caused. It saddens me to think about what my neighbor might have gone through in those last days. Then I remember that more than 900,000 other Americans and almost 6 million people worldwide went through the same thing and, well, that’s just impossible to fathom.  

Kansas COVID Update, Week 81

New cases and hospitalizations continue to fall rapidly. Kansas is still at a "high" transmission level under the CDC's guidance, but so is every other state except Maryland. We're moving in the right direction. As seen in other countries, the omicron wave is receding as quickly as it came. By mid-March we should be in really good shape.

The Good: Test positivity dropped again, from 22.1% to 16.2%, according to Johns Hopkins. I honestly can't remember the last time it was that low. Kansas is now eighth-worst in the nation. Still need more testing.

The Also-Good: Hospitalizations continue to plummet: 

• Statewide COVID hospitalizations fell from 889 to 639 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU fell from 203 to 119. 
• COVID hospitalizations in the Wichita area fell from 218 to 137, and cases in ICU fell from 54 to 45. Both Wichita hospitals are still managing through contingency plans, but they have now moved their status from "critical" to "cautious" for the first time in months. 
• COVID hospitalizations in the KC area (bistate) fell from 922 to 671 and cases in ICU fell from 179 to 114. 
• Overall ICU availability in the KC area rose from about 14.7% to 19.2%. But regular hospital bed availability stayed steady at about 15%. We are probably still working through a lot of delayed medical care, and even after the omicron surge has fully petered out, it will take time to catch up on that and ease bed space.

The Not-As-Good: The infection reproduction rate, Rt, rose from 0.64 to 0.69 this week. The Rt seems to be fluctuating a lot in the past couple weeks as the surge dissipates. I think it's very possible that last week's number was a bit artificially low and 0.69 represents a data correction more than a trend toward more transmission. In any case, both 0.64 and 0.69 are good numbers that will continue the rapid downward trend of total cases. 

Kansas COVID-19 Update, Week 80

 

Another good week. New cases continue to fall rapidly and test positivity is also declining, which means we can be quite certain the dip in cases is real. Hospitalizations are also trending down for the second straight week, though they're still at kind of unmanageable levels. We are on the back end of the omicron surge, but hospitalizations and deaths will likely remain stubbornly high for another couple weeks as the effects of the surge dissipate.

The Good: The infection reproduction rate, Rt, plummeted from 1.0 to 0.64 in Kansas this week. I have trouble believing that such a drastic change really happened in one week, so I think last week's number was probably overinflated and the website I use to find Rt is finally catching up with the declining case counts. In any case, this is really good news.

The Not-Bad: Test positivity fell again, from 29.8% to 22.1%, according to Johns Hopkins. That's still sixth-highest in the nation, but we're definitely trending in the right direction.

The Still-Bad-But-Getting-Better: Hospitalizations are headed down for sure, but they're still quite high and hospital capacity is still quite tight. It may be that people who had their non-COVID medical care delayed during the surge are now getting in for their procedures. That's good, but it's going to take weeks or even months for us to catch up.   

• Statewide COVID hospitalizations fell from 1,091 to 889 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU fell from 236 to 203. 
• COVID hospitalizations in the Wichita area fell from 272 to 218, and cases in ICU fell from 67 to 54. Both Wichita hospitals are still managing through contingency plans, but hopefully should be able to resume normal operations soon. 
• COVID hospitalizations in the KC area (bistate) fell from 1,116 to 922 and cases in ICU fell from 211 to 179. 
• Overall ICU availability in the KC area rose from about 14.3% to 14.7%. But regular hospital bed availability actually dropped a bit, from 16% capacity available to about 15%. It seems like a lot of people are ready to move past the pandemic, but if you work in a hospital it's not really possible to do so. It's still dominating every work day.

Kansas COVID-19 Update, Week 79

 

Things continue to trend in the right direction, increasing my confidence that we're now on the back end of the omicron surge. New cases are trending down, and we saw our first real dip in hospitalizations in a long time this week. But overall hospitalizations remain high, so it's not time to declare victory yet.

The Good: Test positivity dropped again this week, from 36.8% to 29.8%, according to Johns Hopkins. Kansas remains sixth-worst in the country in this metric, but that's two straight weeks of substantial decline. 

The Not Bad: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. I would love to see a bigger decline, but if this is accurate, it at least means that we're stable now. I still expect to see this number below 1.0 soon, given that both new cases and test positivity are declining.

The Still-Bad-But-Getting-Better: COVID-19 hospitalizations have fallen in Kansas, but they've only fallen from about as high as they've ever been (1,250) to almost as high as they've ever been. I doubt hospital workers are feeling much relief yet. Here's the breakdown:

• Statewide COVID hospitalizations fell from 1,243 to 1,091 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU fell from 250 to 236. 
• COVID hospitalizations in the Wichita area fell from 294 to 272, and cases in ICU fell from 72 to 67.
• COVID hospitalizations in the KC area (bistate) fell from 1,224 to 1,116 and cases in ICU fell from 220 to 211. 
• Overall ICU availability in the KC area rose from about 13.7%, to about 14.3%.  Regular hospital beds were at about 16% capacity available, which is also only a very slight increase from last week. Bed space is still pretty tight. Need to get above 20% before hospitals have any real breathing room.  

Kansas COVID-19 Update, Week 78

 

Things are still pretty dire, but there are signs that the awful wave we're in may have finally peaked, especially in the KC area. New cases are coming down from the crazy highs of a week or two ago, and COVID hospitalizations also are flat this week compared to last week (though still extremely high — at or near the highest they've ever been). 

The Good: Test positivity fell from 43.4% to 36.8% this week, according to Johns Hopkins. That's still quite high, and sixth-worst in the country (behind Alaska, New Jersey, Utah, Tennessee and Alabama). But it's a definite step in the right direction.

The Bad: The infection reproduction rate, Rt, remains at 1.1. That would mean that cases are still increasing, albeit slowly. There is a lag in this measurement, however, and I'm cautiously optimistic that if we have another week of lower total positive tests and lower test positivity, Rt will go below 1.0.

The Ugly: Hospitalizations, while not higher than last week, are still really, really high. Here's how it breaks down:

• Statewide COVID hospitalizations went from 1,258 to 1,243 this week, according to the Kansas Hospital Association.

• Statewide cases in ICU went from 279 to 250. 

• COVID hospitalizations in the Wichita area rose from 277 to 294, but cases in ICU fell from 80 to 72.

• COVID hospitalizations in the KC area (bistate) fell from 1,371 to 1,224 and cases in ICU fell from 250 to 220. 

• Overall ICU availability in the KC area rose from about 11.4% to about 13.7%, but regular hospital beds remained at about 15% capacity available. Basically, there's a little bit more cushion in KC this week, but not much. 

Kansas COVID-19 Update, Week 77

 

Things continue to be rough in Kansas. We've now basically equaled our previous peak of covid hospitalizations set in December 2020, although we haven't quite reached our ICU admissions peak. It is hard to fathom how this happened, given that this year we have vaccines and in December 2020 we did not. But vaccines are only good if people receive them. KU Hospital's daily covid updates have generally shown that about 90-95% of their covid patients are unvaccinated. A Kansas City Star article this week showed similar numbers for Saint Luke's (10 vaccinated covid patients out of more than 200 hospitalized for covid). Large numbers of unvaccinated people plus new more contagious variants is a recipe for disaster. The CDC is out with new data this week showing that with boosters the vaccines continue to hold up extremely well against Delta and Omicron. This is the key to getting us out of this bleak winter: getting vaccinated, getting boosted.

The Good: The infection reproduction rate, Rt, is back down to 1.1 this week after that insane jump to 2.7 last week. That suggests that it might have been a data fluke like I had hoped. We still want to get this number below 1.0 though. That's the only way to provide some light at the end of the tunnel for our hospitals.

The Bad: Test positivity rose from 42.5% to 43.4% this week, according to Johns Hopkins. Not a huge jump, but it was already quite high. Kansas is fifth in the country behind Alabama, Alaska, New Jersey and Utah.

The Ugly: Here are the hospital numbers:

• Statewide COVID hospitalizations are up from 1,128 to 1,258 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 271 to 279. The bar to getting admitted to an ICU is extremely high right now. All 279 of those people are extremely ill.
• COVID hospitalizations in the Wichita area rose from 253 to 277, and cases in ICU rose from 77 to 80.
• COVID hospitalizations in the KC area (bistate) rose from 1,294 to 1,371 and cases in ICU rose from 246 to 250. 
• Overall ICU availability in the KC area fell from 12.5% to about 11.4%. Even regular hospital beds were down to about 15% capacity available, which is as low as I've seen it. Given the staff shortages, hospitals are functionally full. Bursting at the seams, in fact.

Kansas COVID-19 Update, Week 76

 

I'm going to keep this short and sweet, because everything is bad. Now is not a good time to need hospital care, for any reason. 

The Bad: Test positivity in Kansas rose from 36.9% to 42.5% this week, according to Johns Hopkins. That's fourth-worst in the country, behind Alaska, New Jersey and Utah. 

The Worse: Things continue to get tougher for our hospitals:

• Statewide COVID hospitalizations are up from 987 to 1,128 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 242 to 271.
• COVID hospitalizations in the Wichita area rose from 209 to 253, while cases in ICU there rose from 62 to 77.
• COVID hospitalizations in the KC area (bistate) rose from 1,047 to 1,294 and cases in ICU there rose from 213 to 246. 
• Overall ICU availability in the KC area actually rose from 9.14% to 12.5% and the raw number of ICU beds available rose from 50 to 77. That means that there are fewer people in ICU for non-covid reasons this week, which gives KC hospitals a lucky bit of breathing room, but not any lasting relief.

The Ugly: The infection reproduction rate, Rt, soared from 1.1 to 2.7 this week. That's an enormous jump; definitely the biggest I've seen in Kansas from one week to the next. My hope is that this is a fluke of data — like maybe there were a lot of backed up tests during the holiday season that all got processed and reported in a big data dump this week. If not, then the virus is spreading incredibly fast in our area and our hospitals are in a very big bind.

Bonus: Amid all of this badness comes a new analysis that found that insurance companies and Medicare spent almost $130 million last year on ivermectin, a prescription drug that has not been proven to prevent or treat covid, but has nonetheless gained a rabid cult following among people who think it does (kind of like hydroxychloroquine in 2020). Ivermectin is extremely cheap by the pill and is usually only prescribed to treat very rare parasitic infections, so that huge price tag suggests that a whole lot of Americans have been taking it for covid (which, again, doesn't work, according to the published clinical evidence). Insurance companies don't have to cover these "off-label" uses, but it seems as though a lot of them have been because, again, ivermectin's pretty cheap on a per-pill basis so maybe not worth challenging each claim. In the grand scheme of America's total health care spending, $130 million is not a ton (though it's not chump change either). But that number still illustrates how much medical misinformation has taken hold of our population. 

 

Kansas COVID-19 Update, Week 75

Well, if you've been paying any attention, you know things are bad right now. Yes, Omicron is less severe, some percentage of the people who get it will still have to be hospitalized, especially if they're unvaccinated. And right now it's spreading so fast that even that small percentage is enough, in raw numbers, to overwhelm hospitals. Hospitals in some highly vaccinated regions are seeing lots of people with "incidental covid," meaning they were hospitalized for something else and then tested positive for covid in the hospital, but don't really have covid symptoms. This is the Omicron effect. It does not result in as much of a net increase in hospitalizations (although it does still strain resources because those patients have to be isolated). But that does not seem to be what's going on in our region. Our hospitals seem to be fighting a double whammy: severe covid cases caused by unvaccinated Delta and Omicron patients, and staff shortages driven by mild Omicron breakthrough infections. We haven't yet matched last winter's high-water mark for covid hospitalizations (about 1,250), but we're close (about 1,000) and our hospitals have less capacity to deal with it this year.

The Good: The infection reproduction rate, Rt, is still at 1.1 according to the site I use. It's good that it hasn't increased, but we're still above the level where cases would start going down. The curve, while not any steeper, continues on an upward trajectory. 

The Bad: Test positivity in Kansas is 36.9%, according to Johns Hopkins (I'm citing calculation Approach No. 5, since that is the one that allows comparisons to the most other states). That's fourth-worst in the country behind New Jersey, Alabama and Utah. 

The Ugly: Here's this week's hospital situation:

• Statewide COVID hospitalizations are up from 827 to 987 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 232 to 242.
• COVID hospitalizations in the Wichita area rose from 181 to 209, while cases in ICU there fell from 66 to 62.
• COVID hospitalizations in the KC area (bistate) rose from 840 to 1,047 and cases in ICU there rose from 196 to 213. 
• Overall ICU availability in the KC area fell from 10.02% to 9.14%. There are about 50 ICU beds left in the entire metro area. And this is a metro with about 25 hospitals. Every facility is basically full, or nearly full.  

Bonus: As of Saturday morning, KU Hospital (the largest in the state) was reporting 139 covid patients. Only 8 were fully vaccinated (the hospital's FB page has helpfully clarified that "'Fully vaccinated' is someone who has received two doses of the respective mRNA vaccines or one shot of the Johnson and Johnson vaccine. Booster shots are not included in the definition.") I just don't know how anyone can look at those numbers and say the vaccines aren't working. If they weren't doing anything, we would expect about 55% of those hospitalized to be vaccinated (because about 55% of all Kansans are fully vaxxed). Instead, it's about 6%. The effect of the vaccine is even more striking if you adjust for age. The Kansans who should be most at risk of hospitalization (the elderly) are 90% fully vaccinated, while the unvaccinated (including 0-5 year-olds) skew young and should have less hospitalization risk. Yet it's the younger, unvaccinated half of our state's population that is swamping our biggest hospital. If that isn't an ironclad argument in favor of vaccination, I don't know what is. 

Kansas COVID-19 Update, Week 74

 

Skipped the blog last week to spend time with family over Xmas. Consequently, all of the numerical comparisons this week will be to numbers from two weeks ago. It wasn't pretty then, and it's worse now.

The Good: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. That's good if it's accurate because it means our new cases have plateaued. But right now they're at too high a level for our health career system anyway, so a plateau is not good enough. We need a reduction in new cases, which will only happen if this number falls below 1.0. And even then, there's going to be some lag before hospitals feel relief. 

The Bad: Test positivity in Kansas rose from 48.3% to 62.0% this week, according to Johns Hopkins. Sounds crazy high, but seven other states (Rhode Island, DC, Delaware, Pennsylvania, Wyoming, Indiana and Missouri) are even higher now. It's bad all around. But without more testing we can't be fully confident in our Rt number.

The Ugly: Here's the hospital situation:

• Statewide COVID hospitalizations are up from 758 to 827 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 199 to 232.
• COVID hospitalizations in the Wichita area rose from 169 to 181 and cases in ICU there rose from 59 to 66.
• COVID hospitalizations in the KC area (bistate) rose from 727 to 840 and cases in ICU there rose from 150 to 196. 
• Overall ICU availability in the KC area fell from 12.75% to 10.02%. This is critical.

Bonus: The combination of rising COVID hospitalizations and staff shortages due to infection are pushing hospitals across the state to the brink. Topeka's largest hospital had to stop accepting patient transfers just before Christmas. Wichita's hospitals are treating people in ER waiting rooms, where some of them have been stuck for days, waiting for a bed. Things are no better across the state line, where Missouri hospitals are enduring some of the nation's worst staffing shortages. All of which means that the big hospitals that normally take in critically ill patients from rural facilities are often no longer able to, and Kansans who need a higher level of care are increasingly stuck in those smaller, lesser-equipped hospitals. And these aren't just COVID patients, either. Everyone who needs an ICU bed in the state for any reason is potentially in a bind now. Much of it is preventable, too. Wesley Medical Center, one of the state's largest, reports that about 95% of its COVID patients are not fully vaccinated. As of Friday, KU Hospital (which is the state's largest) reported that only 5 of its 104 COVID patients were fully vaccinated (odds are those five have some sort of condition that impairs their immune system, like an organ transplant or cancer treatments). Kansas is showing that during Delta/Omicron surge, if you have about half your population vaccinated, your health care system can still be crushed by the other half that's not vaccinated.