Kansas COVID-19 Update, Week 69

It looks like the beginning of the winter surge is upon us. New cases are up, and hospitalizations are up too. For now, deaths still seem to be trending down from September/October levels, but deaths are of course a lagging indicator. This year's winter surge is not likely to be as bad as last year's, especially in terms of hospitalizations and deaths, because of the vaccines. But this year we also seem to have more people in hospital beds for non-COVID reasons. So, a friendly reminder: you can get your annual flu shot and a COVID booster at the same time.  

The Good: The infection reproduction rate, Rt, rose from 0.96 to 1.0 in Kansas this week. That qualifies as good news this week because the rest of the news is worse and also because, if you read last week's blog, you know that I wasn't super confident in that 0.96 figure anyway. In fact, given our lack of testing, I'm guessing 1.0 might be artificially low too. 

The Bad: COVID hospitalizations statewide rose from 393 to 443, according to the Kansas Hospital Association. Of those, 114 are in ICU. Hospitalizations in the Wichita area fell from 102 to 97, but the number of cases in ICU remained at 51.  ICU availability in KC area hospitals fell from 18% to 17%. 

The Ugly: Test positivity rose from 37% to 37.6%, according to Johns Hopkins. That's still fourth-worst in the country behind Iowa, Oklahoma and Idaho. And Kansas is still running the fifth-least tests per capita in the U.S. One caveat: these numbers, for the most part, don't include at-home tests. The news this week that Lee Norman is stepping down as KDHE secretary spurred me to go back and listen to an interview he did for the Kansas Reflector podcast in May. In it he predicted that the rise in at-home tests would skew test positivity numbers because negative at-home test results are almost never going to be reported, while most positive results probably will be eventually (when a patient gets a PCR test to confirm the positive). I can confirm that this has happened in my house. My wife and I have run several at-home tests, they've all been negative, and those negatives weren't figured into any official test positivity data. That could be playing a role in keeping Kansas' test positivity stubbornly high, especially if Kansans are relying on at-home tests more than residents of other states. 

Bonus: Throughout the pandemic I have found Eric Topol's Twitter feed to be invaluable. He's a physician-researcher with a "just the facts" style who does a really good job of spotlighting important, reliable studies and then putting their results in context. This week he spotlighted the first randomized, controlled trial to show the effect of COVID boosters. All 10,000 participants in the study had gotten two doses of the Pfizer vaccine earlier this year. One group was given a real booster, and the control group was given a placebo "booster." Both groups were then watched for two months. The results were striking: the group that got the actual booster saw their protection against symptomatic infection rise to 95% within seven days. And the best part? There were actually more adverse events reported by the placebo group than by the group that got the actual booster, suggesting it's extremely safe. Now, the people in the placebo group remained well-protected against severe illness from their first two shots — none were hospitalized for COVID and only two suffered a "severe" case (determined by an oxygen saturation level of 93% or below). But they were more likely to get an infection (which can still be pretty crummy, if not life-threatening) and therefore more likely to pass the virus along to others. Boosters are now open to all adults, and the data shows they can really help our communities stem the spread.     

Kansas COVID-19 Update, Week 68

The general pattern of the past month continues to hold. New cases remain high in Kansas, but not as high as they were in August or September, and they're not really increasing or decreasing much at all. I hope this is not the new normal. We're still averaging about 20 COVID deaths per week as a state, which would be more than 1,000 a year. While that's certainly a lot better than the first 12 months of the pandemic, when we suffered about four or five times that many deaths, it still seems like a pretty high price to pay. Hopefully vaccines for kids 5-11 will help reduce transmission.

The Good: The infection reproduction rate, Rt, fell from 1.0 to 0.96 this week.  The caveat to that is that getting a really precise Rt number relies on having robust testing in place, and there's ample evidence we aren't testing near enough in Kansas. 

The Bad: COVID hospitalizations statewide barely budged this week, going from 402 to 393, according to the Kansas Hospital Association. Cases in Wichita's hospitals fell from 113 to 102, but cases in ICU there actually rose from 48 to 51 and those hospitals remain over their normal ICU capacity. ICU capacity in the Kansas City area is also slightly more pinched, going from 22.5% to 18% this week. 

The Ugly: Test positivity rose from 33% to 37% this week, according to Johns Hopkins. That's third-worst in the nation behind Iowa and Idaho. Only five states are currently running fewer weekly tests per capita than Kansas. Four states (Vermont, Massachusetts, Rhode Island and Illinois) are each running at least 10 times more. That's why I can't be super confident about that Rt dip. 

Bonus: Children are at lower risk for severe COVID-19 than adults, but sadly some do get very ill from it, and some even die. We have seen it happen right here in Kansas, including again this week, with our sixth pediatric death of the pandemic. It's important to know that the new vaccine approved for kids 5-11 is a lower dose specially formulated for that age group. In clinical trials it provided robust protection (because kids that age have very responsive immune systems) without any evidence of the rare side effects (myocarditis) observed in some (mostly young men) who received the adult dosage. In fact, so far no serious side effects of any kind have been observed in the trial participants. It's a smaller sample size than the clinical trials for the adult vaccine, but so far the kids' dose looks extremely safe and effective.     

Kansas COVID-19 Update, Week 67

We continue to be in sort of a holding pattern in terms of new cases. After a steady decline through the month of September, we've been at essentially the same rate for more than a month. That rate is nowhere near last year's November/December surge, or even this summer's Delta surge, but it's still pretty high: about 1,000 new cases per day, in a state of 3 million people. That's far too many for us to trace and isolate, like we would with infectious diseases like measles. But the good news is that hospitalizations continue to fall, and a new drug that should keep more COVID patients out of hospital beds is on the way.  

The Good: Total COVID hospitalizations statewide fell from 454 to 402 this week, according to the Kansas Hospital Association. That's much better than the week before, when the number barely moved. Sedgwick County's ICUs remain over normal capacity, but their COVID hospitalizations fell from 133 to 113 this week. Unfortunately, cases in ICU only dropped from 50 to 48. ICU availability in the Kansas City metro rose from 20% to about 22.5% this week. Not a huge jump, but it's the right direction.

The Bad: The infection reproduction rate, Rt, once again stayed the same at 1.0. That tracks with our steady case rates. New cases won't fall until we get Rt below 1.

The Ugly: Test positivity stayed basically the same, going from 33.2% to 33.0%, according to Johns Hopkins. Still fourth-worst in the country behind Idaho, Iowa and Oklahoma. With Rt hovering right at 1.0, it would be nice if we could be more confident that we're testing enough to catch most infections. But we're not. 

Bonus: Colorado continues to feel a major hospital bed crunch, with only about 100 ICU beds available across the entire state (a population of almost 6 million, and more if you include all of the people who live in rural parts of surrounding states like Kansas and rely on places like Denver and Grand Junction for ICU care). COVID-19 is not the only thing driving the bed space shortage there, but it's definitely a factor. And it should be much less of one. About 35% of Coloradoans (the unvaccinated) currently account for about 80% of all COVID hospitalizations. Which suggests you have a much, much lower risk of hospitalization if you've been vaccinated. It's the same story all over. In the country of Luxembourg, the 30% of the population that's unvaccinated accounts for 82% of COVID hospitalizations. In Sedgwick County, the 37% of the population that's unvaccinated accounts for 88% of COVID hospitalizations. We have the tools to solve this problem. We just need to convince more people to use them. 

Kansas COVID-19 Update, Week 66

We're at a plateau right now. New cases have leveled off and may even be rising again slightly. Hospitalizations are also barely going down now. I'm  concerned about the news coming out of Colorado, where new cases and hospitalizations are causing a health care crunch. That will affect western Kansas, not only as the virus spreads across state lines, but also as Kansans who depend on large hospitals in Denver for high-level care find it more difficult to get transferred there.

The Good: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. That means that each new infection only causes one additional infection, which means the pandemic would stay stable right at the level it's currently at. But we're still currently at a relatively high level of spread in Kansas (almost 10 times higher than we were in early June, before the Delta surge). So this is not where we want to level off.

The Bad: Total COVID hospitalizations statewide have stagnated, falling only from 461 to 454 this week, according to the Kansas Hospital Association. As of Oct. 28, hospitals in the Kansas City area remained pretty much right at 20% ICU availability, which is manageable but not much of a cushion. Hospitals in the Wichita area are still over their normal ICU capacity, but the good news is COVID hospitalizations there fell from 150 to 133 and cases in ICU fell from 62 to 50 this week. 

The Ugly: Test positivity rose from 30.3% to 33.2% this week, according to Johns Hopkins. Very high and getting higher. Only Idaho, Iowa and Oklahoma are worse. 

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.