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.