Kansas COVID-19 Update, Week 76

 

I'm going to keep this short and sweet, because everything is bad. Now is not a good time to need hospital care, for any reason. 

The Bad: Test positivity in Kansas rose from 36.9% to 42.5% this week, according to Johns Hopkins. That's fourth-worst in the country, behind Alaska, New Jersey and Utah. 

The Worse: Things continue to get tougher for our hospitals:

• Statewide COVID hospitalizations are up from 987 to 1,128 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 242 to 271.
• COVID hospitalizations in the Wichita area rose from 209 to 253, while cases in ICU there rose from 62 to 77.
• COVID hospitalizations in the KC area (bistate) rose from 1,047 to 1,294 and cases in ICU there rose from 213 to 246. 
• Overall ICU availability in the KC area actually rose from 9.14% to 12.5% and the raw number of ICU beds available rose from 50 to 77. That means that there are fewer people in ICU for non-covid reasons this week, which gives KC hospitals a lucky bit of breathing room, but not any lasting relief.

The Ugly: The infection reproduction rate, Rt, soared from 1.1 to 2.7 this week. That's an enormous jump; definitely the biggest I've seen in Kansas from one week to the next. My hope is that this is a fluke of data — like maybe there were a lot of backed up tests during the holiday season that all got processed and reported in a big data dump this week. If not, then the virus is spreading incredibly fast in our area and our hospitals are in a very big bind.

Bonus: Amid all of this badness comes a new analysis that found that insurance companies and Medicare spent almost $130 million last year on ivermectin, a prescription drug that has not been proven to prevent or treat covid, but has nonetheless gained a rabid cult following among people who think it does (kind of like hydroxychloroquine in 2020). Ivermectin is extremely cheap by the pill and is usually only prescribed to treat very rare parasitic infections, so that huge price tag suggests that a whole lot of Americans have been taking it for covid (which, again, doesn't work, according to the published clinical evidence). Insurance companies don't have to cover these "off-label" uses, but it seems as though a lot of them have been because, again, ivermectin's pretty cheap on a per-pill basis so maybe not worth challenging each claim. In the grand scheme of America's total health care spending, $130 million is not a ton (though it's not chump change either). But that number still illustrates how much medical misinformation has taken hold of our population. 

 

Kansas COVID-19 Update, Week 75

Well, if you've been paying any attention, you know things are bad right now. Yes, Omicron is less severe, some percentage of the people who get it will still have to be hospitalized, especially if they're unvaccinated. And right now it's spreading so fast that even that small percentage is enough, in raw numbers, to overwhelm hospitals. Hospitals in some highly vaccinated regions are seeing lots of people with "incidental covid," meaning they were hospitalized for something else and then tested positive for covid in the hospital, but don't really have covid symptoms. This is the Omicron effect. It does not result in as much of a net increase in hospitalizations (although it does still strain resources because those patients have to be isolated). But that does not seem to be what's going on in our region. Our hospitals seem to be fighting a double whammy: severe covid cases caused by unvaccinated Delta and Omicron patients, and staff shortages driven by mild Omicron breakthrough infections. We haven't yet matched last winter's high-water mark for covid hospitalizations (about 1,250), but we're close (about 1,000) and our hospitals have less capacity to deal with it this year.

The Good: The infection reproduction rate, Rt, is still at 1.1 according to the site I use. It's good that it hasn't increased, but we're still above the level where cases would start going down. The curve, while not any steeper, continues on an upward trajectory. 

The Bad: Test positivity in Kansas is 36.9%, according to Johns Hopkins (I'm citing calculation Approach No. 5, since that is the one that allows comparisons to the most other states). That's fourth-worst in the country behind New Jersey, Alabama and Utah. 

The Ugly: Here's this week's hospital situation:

• Statewide COVID hospitalizations are up from 827 to 987 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 232 to 242.
• COVID hospitalizations in the Wichita area rose from 181 to 209, while cases in ICU there fell from 66 to 62.
• COVID hospitalizations in the KC area (bistate) rose from 840 to 1,047 and cases in ICU there rose from 196 to 213. 
• Overall ICU availability in the KC area fell from 10.02% to 9.14%. There are about 50 ICU beds left in the entire metro area. And this is a metro with about 25 hospitals. Every facility is basically full, or nearly full.  

Bonus: As of Saturday morning, KU Hospital (the largest in the state) was reporting 139 covid patients. Only 8 were fully vaccinated (the hospital's FB page has helpfully clarified that "'Fully vaccinated' is someone who has received two doses of the respective mRNA vaccines or one shot of the Johnson and Johnson vaccine. Booster shots are not included in the definition.") I just don't know how anyone can look at those numbers and say the vaccines aren't working. If they weren't doing anything, we would expect about 55% of those hospitalized to be vaccinated (because about 55% of all Kansans are fully vaxxed). Instead, it's about 6%. The effect of the vaccine is even more striking if you adjust for age. The Kansans who should be most at risk of hospitalization (the elderly) are 90% fully vaccinated, while the unvaccinated (including 0-5 year-olds) skew young and should have less hospitalization risk. Yet it's the younger, unvaccinated half of our state's population that is swamping our biggest hospital. If that isn't an ironclad argument in favor of vaccination, I don't know what is. 

Kansas COVID-19 Update, Week 74

 

Skipped the blog last week to spend time with family over Xmas. Consequently, all of the numerical comparisons this week will be to numbers from two weeks ago. It wasn't pretty then, and it's worse now.

The Good: The infection reproduction rate, Rt, fell from 1.1 to 1.0 this week. That's good if it's accurate because it means our new cases have plateaued. But right now they're at too high a level for our health career system anyway, so a plateau is not good enough. We need a reduction in new cases, which will only happen if this number falls below 1.0. And even then, there's going to be some lag before hospitals feel relief. 

The Bad: Test positivity in Kansas rose from 48.3% to 62.0% this week, according to Johns Hopkins. Sounds crazy high, but seven other states (Rhode Island, DC, Delaware, Pennsylvania, Wyoming, Indiana and Missouri) are even higher now. It's bad all around. But without more testing we can't be fully confident in our Rt number.

The Ugly: Here's the hospital situation:

• Statewide COVID hospitalizations are up from 758 to 827 this week, according to the Kansas Hospital Association.
• Statewide cases in ICU rose from 199 to 232.
• COVID hospitalizations in the Wichita area rose from 169 to 181 and cases in ICU there rose from 59 to 66.
• COVID hospitalizations in the KC area (bistate) rose from 727 to 840 and cases in ICU there rose from 150 to 196. 
• Overall ICU availability in the KC area fell from 12.75% to 10.02%. This is critical.

Bonus: The combination of rising COVID hospitalizations and staff shortages due to infection are pushing hospitals across the state to the brink. Topeka's largest hospital had to stop accepting patient transfers just before Christmas. Wichita's hospitals are treating people in ER waiting rooms, where some of them have been stuck for days, waiting for a bed. Things are no better across the state line, where Missouri hospitals are enduring some of the nation's worst staffing shortages. All of which means that the big hospitals that normally take in critically ill patients from rural facilities are often no longer able to, and Kansans who need a higher level of care are increasingly stuck in those smaller, lesser-equipped hospitals. And these aren't just COVID patients, either. Everyone who needs an ICU bed in the state for any reason is potentially in a bind now. Much of it is preventable, too. Wesley Medical Center, one of the state's largest, reports that about 95% of its COVID patients are not fully vaccinated. As of Friday, KU Hospital (which is the state's largest) reported that only 5 of its 104 COVID patients were fully vaccinated (odds are those five have some sort of condition that impairs their immune system, like an organ transplant or cancer treatments). Kansas is showing that during Delta/Omicron surge, if you have about half your population vaccinated, your health care system can still be crushed by the other half that's not vaccinated. 

Kansas COVID-19 Update, Week 73

At this point you probably don't need me to tell you that things aren't going well. Kansas hospital leaders are sounding that alarm almost daily. We have not matched last year's peak of COVID hospitalizations yet, but they keep climbing. With more patients suffering from flu and other illnesses this winter, hospitals are already filling fast. Meanwhile new COVID cases continue to climb rather steadily, suggesting no relief around the corner. Omicron, which is here but probably not in huge numbers yet, could make it all worse, unless we get more people vaccinated and boosted.

The Good: The infection reproduction rate, Rt, remained at 1.1. It's the best news we have this week, but still not great, because as long as that number's above 1.0 the overall number of active infections will continue to rise. 

The Bad: Test positivity in Kansas rose from 47.3% to 48.3%, according to Johns Hopkins. That's second-worst in the country behind Wisconsin. Our testing numbers remain elevated from where they were a few weeks ago, but seem to have kind of leveled off. 

The Ugly: Here's the hospital situation broken down in chunks:

• Statewide COVID hospitalizations are up from 668 to 758, according to the Kansas Hospital Association.
• Cases in ICU statewide fell from 201 to 199.
• Hospitalizations in the Wichita are went from 159 to 169, and cases in ICU there went from 57 to 59. 
• Hospitalizations in the Kansas City area rose from 600 to 727, and cases in ICU there rose from 139 to 150.
• ICU availability in the KC area fell from 13.24% to 12.75%. 

Bonus:  Omicron will hit hard and fast. But the good news is, once we get through the surge, the decline should also be rapid. Breakthrough infections are a given with omicron, but booster shots can reduce them substantially and those that occur in fully vaccinated people are not likely to be serious, unless they're old or immunocompromised. 

Kansas COVID-19 Update, Week 72

We are smack in the middle of the fall/winter surge now. Thanks to vaccines our case numbers are not as high as they were last year at this time, but they're now the second-highest they've ever been, surpassing even this summer's Delta-driven surge. Delta is still circulating, people are increasingly gathering indoors, and the air is colder and drier which allows respiratory viruses to spread more easily. It's a dangerous combo. If this year's fall/winter surge follows the same pattern as last year's, we may see a bit of a lull in new cases in the next week or two, as the Thanksgiving infections resolve, then another spike after Christmas/New Year's, followed by a steady drop off in January and February. But no real relief for hospitals until probably mid-to-late February. 

The Good: Test positivity fell from 52.6% to 47.3%, according to Johns Hopkins. To be clear, that is still quite high (even based on Hopkins' methodology, which skews higher than others). It's still second-highest in the country, in fact, behind only Iowa. But there's been a clear increase in testing in Kansas. We've more than doubled our per-capita testing rate and, though we're still nowhere near the states that are testing the most, we're now ahead of seven states that are testing less. So, progress. Knowing who's infected is the first step to slowing the spread. This all comes with the caveat that at-home tests are making it increasingly hard to calculate test positivity (because results from at-home tests aren't usually reported, especially if they're negative). 

The Bad: The infection reproduction rate, Rt, rose from 1.0 to 1.1. This is to be expected. Cases are clearly on the rise. In fact, there's a good chance the true Rt is even higher than 1.1; but the increase in testing allows us to have a little more confidence in this number going forward.

The Ugly: COVID-19 hospitalizations are rising, and fast. They're up statewide this week from 545 to 668, according to the Kansas Hospital Association. Remember how I said last week that we were likely to see a surge in ICU admissions? Well, they're up from 138 to 201. The increase seems to be mainly in eastern Kansas. Wichita's hospitalizations actually dropped from 172 to 159 (and cases in ICU dropped from 58 to 57). But the KC metro's COVID hospitalizations rose from 505 to 600 this week (that includes hospitals on both the Kansas and Missouri side of the state line. Only 186 of those are included in the Kansas Hospital Association's statewide total) and ICU cases went from 128 to 139. ICU availability in the KC metro has fallen to 13.24%. Anything below 20% is dangerous. Anything below 10% is critical and probably means some patients aren't getting the care they need. 

Bonus: The picture on Omicron is becoming increasingly clear. It's more transmissible than past variants, but not more severe (and may even be less severe). It has more immune evasiveness than previous variants, but two doses of Pfizer or Moderna plus a booster or a prior infection seem to still provide pretty robust protection. So get those boosters if you haven't already.

Kansas COVID-19 Update, Week 71

Well, we're about a week out from Thanksgiving and we seem to be experiencing a significant spike in new cases as a state. It's having a worrisome effect on our hospital capacity. I know everyone is tired of hearing they should get vaccinated, mask up and social distance, but if we don't start doing more of all three, it could be a rough holiday season. Our COVID numbers are not as bad as last year's deadly winter surge, but this year we have more flu (probably because people have taken off their masks) and other illnesses to deal with at the same time. 

The Good: The infection reproduction rate, Rt, is still estimated at 1.0 (with a potential range of 0.86 to 1.3, which is a huge variance because of our lack of testing). But even that bit of good news is probably short-lived. Given the rate of new cases in the past few days I think once the data reporting catches up, that Rt number is almost certainly going to rise.

The Bad: Hospitals are increasingly crunched. COVID hospitalizations statewide are up from 478 last week to 545 this week, according to the Kansas Hospital Association.  That's only about half of the last year's peak hospitalizations (thank you, vaccines) but still a lot to deal with. Oddly, ICU cases are down, but only from 144 to 138. Given the increase in hospitalizations, I would expect that to change over the next week. Sedgwick County's ICUs are overloaded. COVID hospitalizations there jumped from 135 to 172, and cases in ICU went from 50 to 58. Kansas City area hospitalizations rose from 342 to 505 and cases in ICU went from 88 to 128. ICU availability in the metro area is down to 15%.

The Ugly: Test positivity rose from 42.4% to 52.6%, according to Johns Hopkins.  That's second-worst in the country, ahead of only Iowa. Only Iowa and Idaho are running fewer tests per capita. Vermont, the nation's leader in testing, is now running 22 times more per capita tests than Kansas. 

 

Kansas COVID-19 Update, Week 70

Not a lot of good news this week. New cases still going up. Hospitalizations too. There was also a one-day spike in deaths on Nov. 19, though that's not enough to establish a trend. This seems to be the winter surge. Last year our new cases peaked right around this time, at a rate more than twice as high, leading to extreme death in December and January. I think it would be naive to believe the peak will come at precisely the same time this year. We may be there, we may not be. 

The Good: The infection reproduction rate, Rt, remained at 1.0 this week. We aren't testing near enough to be confident in that exact number (the website I use gives us a range of anywhere from 0.83 to 1.5), but if that's right, it's good news because it means infections aren't increasing. But they're not decreasing either.

The Bad: COVID hospitalizations statewide jumped from 443 to 478, according to the Kansas Hospital Association. Cases in ICU are up from 114 to 144. Wichita's hospitals saw a steep rise in cases this week, from 97 to 135. Cases in ICU there dropped from 51 to 50, but given the overall hospitalization numbers, it's only a matter of time before those are back on the rise. Kansas City area hospitals had 342 COVID patients this week, including 88 in ICU. ICU availability remained at 20% there, though. 

The Ugly: Test positivity rose from 37.6% to 42.4%, according to Johns Hopkins. That's second-worst in the country behind Iowa. Kansas is also basically tied with Idaho for lowest per-capita testing rate. Vermont is testing 20 times more than Kansas. 

Bonus: About 600 passengers on two planes traveling from South Africa to Amsterdam were stopped upon arrival and tested for COVID, because of the new Omicron variant. Sixty-one tested positive, though it's still unknown exactly how many had the Omicron variety. This will be something to keep an eye on.