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.