Kansas COVID-19 Update, Week 34

Again this week the metrics themselves are overall pretty good, but the trends are mixed. Some numbers are moving in the right direction, some are stagnant and some are going the wrong way. I still think it's possible we will see another spike in cases in the next couple months, but I remain optimistic that vaccines and acquired immunity from prior infections will blunt it (more on that below).

The Good: Test positivity continues to fall steadily in Kansas, from 17.6% last week to 13.7% this week, according to Johns Hopkins. After months of watching this metric stick stubbornly above 20% (or even 30%), the recent multi-week decline has been really good to see. Kansas is still fourth-highest in the country in this metric, but the three states that are worse (Idaho, Alabama, Iowa) are all significantly worse (18% or more). Kansas is finally headed in the right direction. 

The Bad: Hospital ICU capacity remained unchanged at 30% this week, according to the Kansas Hospital Association. The number itself is not bad — 30% capacity is plenty manageable if it stays there. But it's not a huge cushion in the event that we do face another surge. The south-central Kansas region remains the foremost potential trouble spot, at 14% capacity. 

The Ugly: The infection reproduction rate rose from 0.83 to 0.88. Again, 0.88 is not a bad number, but it's the trend that's ugly. This is now several straight weeks that this number has gone up. Here's the thing, though: based on the decreasing test positivity rate, it could be that previous estimates of Rt in Kansas were artificially low because we weren't testing enough to identify most cases. It's likely that we were never really as low as 0.82 and we're now getting closer to an accurate picture of how much infection we're truly spreading. As long as it stays below 1.0, and the test positivity rate keeps going down, we can feel good about where we're heading. 

Bonus: About 8.5% of Kansans are now fully vaccinated against COVID-19, according to the New York Times. About 17% of residents are partially vaccinated, which provides at least some protection against infection. This is not nearly enough to convey herd immunity (probably need at least 70%), but when you consider that in some parts of the state close to 50% of people have some measure of acquired immunity from getting COVID in the past year, we may be getting close in some regions. And the people not yet vaccinated right now skew younger, which means they're less likely to end up in the hospital if they do get COVID-19. All of this should hopefully prevent a repeat of November/December, when hospitals were full and desperately seeking transfers for dying patients.  

Kansas COVID-19 Update, Week 33

Last week I said I was cautiously optimistic about where we were in Kansas, but still saw several pitfalls that could cause another COVID-19 wave here (re-openings, coronavirus variants and March Madness gatherings). This week I'm re-upping those concerns. The steep decline in new cases seems to be leveling off, not only in Kansas but nationwide (this New York Times article is a really good explainer of where we're at and what it could mean for the immediate future). If we can stay at this level we're probably OK in a macro sense — there will be more deaths but our health care system will be able to handle the flow of patients. But as we've seen, the coronavirus doesn't usually stay at one level for long. It spreads in waves, and if you're not on the downswing, you're probably not far from the upswing (unless you can get cases to a low enough level that you can test, trace and isolate everyone who's exposed, and we're definitely not there yet).

The Good: Test positivity in Kansas is down! It's below 20% for the first time in months, according to Johns Hopkins, clocking in at 17.6%. Last week it was 22.1%, the worst mark in the country. This week's number is better than four other states (Idaho, South Dakota, Iowa and Alabama). We must be doing a better job of testing. It's possible this coincides with more schools and colleges opening for in-person instruction. Education has generally been among the most diligent industries when it comes to testing. 

The Bad: The infection reproduction rate is up a bit this week, from 0.82 to 0.83. This is not a big jump, and 0.83 is still a really good number. The question is, will it stay there? The lifting of restrictions on bars, restaurants and general gatherings, in addition to new, more contagious variants means the number is likely to rise. What will help keep it down? The same things we've been doing (avoiding gatherings, especially indoors; wearing masks, especially multi-layered well-fitting ones) as well as vaccinations, vaccinations, vaccinations. The data is still preliminary, but so far it looks like several vaccine reduce transmission of the virus as well as reducing illness.

The Ugly: Hospital ICU capacity was down again this week, from 31% to 30%, according to the Kansas Hospital Association. Again, not a huge drop, but the trend is bad. And when you look deeper into the data there's a regional trouble spot: south-central Kansas, aka the Wichita area, which was down to 14% availability this week. That's a little concerning. Just last week Wichita's ICUs dropped below capacity (208 beds) for the first time in months. This week they're trending back toward full, going from 190 patients to 193.  Health care workers there must be exhausted and we haven't left much of a cushion to protect against another wave.  

Kansas COVID-19 Update, Week 32

 

There is still a lot to be optimistic about in this week's numbers. New cases continued to fall to levels not seen since early July. Wichita's ICUs were below capacity for the first time in 15 weeks (yes, you read that right). COVID deaths are tailing off considerably now. But there are still a few reasons to believe another wave could happen before we get enough people vaccinated to end the pandemic. 

The Good: The infection reproduction rate in Kansas continued to fall, from 0.87 last week to 0.82 this week. It's dropping a little more slowly now, but 0.82 is a really good number and means the total number of active cases should continue decreasing steadily. 

The Bad: Despite the good news from Wichita, overall ICU capacity statewide dropped from 34% to 31%, according to the Kansas Hospital Association. Every region of the state remains above 20% availability, so there is nothing critical here, but clearly some hospitals were more full this week, including the University of Kansas Hospital, which added five new COVID-19 patients Friday alone. That led KU's top infectious disease doctor to say the numbers were making him "a little uneasy," and when Dana Hawkinson talks about the pandemic, I listen. What would cause hospitalizations to go up even as overall cases go down? Two possibilities: a lack of testing (we're missing cases) or new variants of the coronavirus that are more likely to cause severe illness (we should probably be testing more for these mutations). 

The Ugly: Test positivity rose from 22.1% last week to 22.7% this week, according to Johns Hopkins. It's not a big jump, but this number really should be going down every week. When it's this persistently high, there are better odds that we're missing lots of cases, which makes it harder for us to stay ahead of surges that lead to lots of hospitalizations and deaths. Kansas now ranks dead last among all of the states in test positivity, at least as calculated by Hopkins. 

Bonus: A Johns Hopkins doctor made headlines Friday when he said that COVID-19 could be "mostly gone" in the USA by April, because new cases keep declining and the number of vaccinated people keeps rising. He might be right. I certainly hope so. But there are a few reasons that I think yet another surge could hit before we have vaccinated enough people to achieve herd immunity.

1. Reopenings (including schools): Bars, restaurants, entertainment venues, they're all opening back up, even in places like the Kansas City area that have been more aggressive about containing COVID-19 than the rest of the state. And state leaders want nearly all kids back in the classroom by next month. This is understandable, given that cases keep declining and businesses have been struggling. But the virus is still circulating, and although it's circulating at a lower level than a month ago, it's still a high enough level that our contact tracing won't be able to keep up. That means untraced transmissions, community spread, and unidentified infectious people who will be increasingly congregating with other people. That's a recipe for another surge.

2. Variants: The UK variant, the South Africa variant, the Brazilian variant — all spread more easily than the traditional COVID-19 coronavirus we've come to know and loathe. And they're making their way to Kansas, slowly but surely. To protect yourself from these mutant viruses, make sure your mask is multi-layered and fits well if you're going to be in close contact with other people, especially indoors. 

3. March Madness: In addition to the mega-spike in the fall caused by the seasonal nature of upper respiratory viruses, we also quite clearly saw mini-spikes of COVID-19 about a week after Thanksgiving and Christmas/New Year's. Which is extremely predictable. Those are times when people gather and when people gather, COVID-19 spreads. The next gathering is March Madness. Even if there will be few fans allowed at the games this year, you can bet they're still going to get together in bars and houses to watch their teams together. And unlike Thanksgiving and Christmas, those games will be happening every weekend for about five straight weeks (more, if you count the conference tournaments leading up to it). With bars open again and new variants floating around, March Madness could very well cause yet another spike. 

Kansas COVID-19 Update, Week 31

We continued on a really good trajectory this week. New COVID cases in the Kansas City area have dropped to their lowest levels since July, and the rest of the state is also declining, though not as quickly in some areas. With any luck, the recent snap of ultra-cold weather will help by keeping people in their homes for another week or so. We don't know when the next COVID wave is coming, but this trough right now is our opportunity to get as many people vaccinated as possible to blunt that wave when it arrives.

The Good: The infection reproduction rate dropped from 0.98 to 0.87 this week. That's huge. This is why cases are dropping so fast. Each infection is now causing only 0.87 subsequent infections, on average. That means a solid portion of people who are getting infected now aren't infecting even a single other person. And that should only continue as the number of vaccinated Kansans increases. 

The Also-Good: Available ICU capacity increased from 29% to 34% this week, according to the Kansas Hospital Association. Every region of the state had at least 22% capacity available. That's a robust number, and should ensure that everybody who enters ICU now has the best chance possible to get out alive. It also means that our health care workers can finally take a breath and some can maybe even take a well-deserved vacation. 

The Bad: Test positivity is still going down in Kansas, but slowwwwwwwly. It dropped from 24.3% to 22.1% this week, according to Johns Hopkins. That's still third-worst in the country, behind only Iowa and Idaho. It's perplexing that this number isn't improving more quickly, given how good the other numbers look. High test positivity means we may be missing lots of infections. But the fact that it continues to go down — however slowly — even as new confirmed cases also go down, signals that we can be confident the steady downward trajectory of new infections is real. 

Kansas COVID-19 Update, Week 30

 

Kansas passed 4,000 COVID-19 deaths this week (the state has confirmed 4,101 as of Feb. 5). The new deaths include, especially tragically, a 6-year-old. We passed 1,000 deaths in late October, we passed 2,000 by Dec. 12, and we passed 3,000 the week of Jan. 9. So the pace of deaths has leveled off, but we're barely at the downturn. Still, there are several signs that a precipitous drop is finally coming.

The Good: Hospital ICU capacity improved from 22% to 29% this week, according to the Kansas Hospital Association. That's an excellent jump. This is the last step before deaths start to really drop: more empty ICU beds. 

The Not-bad: The reproduction rate, or Rt, dropped from 1.0 to 0.98. I'd like to see a bigger decrease, but this new site where I'm pulling the data from seems fairly conservative in its estimates, and an 0.98 still means that total infections are decreasing.  

The Bad: Test positivity in Kansas dropped from 25.7% to 24.3% this week, according to Johns Hopkins. It's barely moving, which gives us some room to doubt just how much new cases are really decreasing (we're clearly missing a lot of cases, we just don't know how many. This is why it's hard to pin down an Rt). However, based on our improving hospitalization figures, they clearly are decreasing. Only Alabama and Idaho currently have worse test positivity numbers than Kansas. 

Kansas COVID-19 Update, Week 29

 

The website that I use to track the infection reproduction, or Rt, has now stopped updating.  So I'm going to start using a different site this week, which is going to temporarily throw the trend data for a bit of a loop. But overall, things are looking pretty good. New cases in Kansas keep declining steadily and the test positivity rate is also down this week, which means the decline in new cases isn't due to less testing. There are still dangers out there — the amount of COVID circulating in some parts of the state is still too high for comfort, and new variants that are more contagious (and maybe more deadly) could still come here and cause significant pain. But the trends are good. It's looking more and more like we have weathered the fall surge and we now have an opportunity, if we can get a lot of people vaccinated, to make sure we don't ever have another wave like that. Which would be great, because we're still averaging 500 deaths every two or three weeks because of the fall surge (we topped 3,500 total this week). 

The Good: Hospital ICU capacity improved to 22% statewide, according to the Kansas Hospital Association. That's only a single percentage point better than last week, but every region of the state was at 12% or better this week, so the beds seem better distributed.

The Neutral: According to this new site I'm using, Kansas' Rt is right at 1.0. That would be worse than last week, but this site calculates Rt in a slightly different way, so it's an imperfect comparison. Let's wait and see what the next few weeks bring. Based on the falling new cases/test positivity, I think we'll be below 1.0 soon.

The Bad: Test positivity dropped from 28.4% to 25.7%, according to Johns Hopkins. The trend is good, but the number's still way too high and I wish it was dropping faster. The more testing we do, the easier it will be to nail down a solid Rt number. As it is, we're not testing enough, which is why we end up with a range of different Rt estimates from different sources. 

Bonus:

This week's bonus is a series of heat maps that show where the virus has been spreading most lately, and where it's been most prevalent/deadly throughout the pandemic. All of them are based on cases/deaths per capita.

This one shows which counties had the most new cases per capita from Jan. 13-27. As you can see, things are looking pretty good, with the exception of a few troublesome counties. 

This one shows which counties had the most new deaths per capita from Jan. 13-27. It looks a lot worse, because deaths are a lagging indicator. Even though new cases are slowing down, lots of Kansans who contracted the coronavirus weeks or even months ago are still dying. 

This one shows which counties have had the most cases per capita since the start of the pandemic. Although cases first started showing up last spring in the Kansas City area, as you can see it's since been western Kansas that has really taken the brunt of things. And this only reflects confirmed cases. 

This one shows which counties have had the most COVID deaths per capita since the start of the pandemic. Again, western Kansas has been absolutely ravaged. When you look at the raw death numbers from those counties they don't look like much, but based on their total populations they're devastating. Indeed, as of mid-January, the top 10 counties for per capita COVID deaths in Kansas all had fewer than 11,000 residents. The pandemic's been bad everywhere, but it's been a nightmare for rural Kansas. 

Kansas COVID-19 Update, Week 28

After a lot of good news last week, this week is more mixed in Kansas. It still appears that we're doing a good job of cutting down new cases, but the downward momentum of test positivity has stalled and our hospital ICUs are actually a bit more full than last week. Could be a result of the ebbs and flows caused by the holiday surge, but it should be a warning not to let our collective guard down. 

The Good: The infection reproduction rate, or Rt, is down yet again, now at 0.95. That's a good number, and the first time it's been that low since Christmas. It's been more than three weeks now since New Year's, so we should have absorbed all the new infections from the holiday surge now, and it doesn't appear that the ripple effect will be long-lasting.

The Bad: Hospital ICU capacity dropped from 25% to 21% this week, according to the Kansas Hospital Association. That may seem counterintuitive, given that the number of new infections is going down now. But remember, there's usually a lag between when a case is diagnosed, and when it results in hospitalization. So this dip in ICU availability, given the timing, could very well reflect the holiday surge. People were exposed to the coronavirus Dec. 25-Jan 1, they started to get sick (and test positive) about a week later and a week or two after that they ended up in the ICU. Fortunately, we have enough of a cushion to be able to absorb that surge and so far stay above 20% capacity statewide, which is a good mark. There are still trouble spots, though. Southwest Kansas was down to 9% capacity, for instance, with only two ICU beds available as of Jan. 22. And there's not a lot of room to transfer patients to Wichita's ICUs, which are still over capacity (although the number of COVID patients in ICUs there is now as low as it's been since the beginning of November).

The Ugly: Test positivity rose from 28.1% to 28.4% this week, according to Johns Hopkins. That's not a huge jump, but it was already quite high. We would like to see some sustained decline in this metric to be sure we're identifying most of our active infections.