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.