Kansas COVID-19 Update, Week 55

The rate of new cases in the Kansas City metro area is now higher than it ever was last summer (though still not nearly as high as during the nightmarish fall/winter surge). Given the transmissibility of the Delta variant, it seems destined to just keep rocketing up, right? Maybe, but something interesting has happened with Delta in England. After about a month or two of extreme surge, new cases there have dropped rapidly in the last two weeks. England has a slightly higher vaccination rate than the U.S., and much higher rate of masking (95% of people there are doing it, according to one survey), so it's not a perfect comparison. But cases have also declined rapidly in India after Delta ravaged that country. It could be that Delta spreads so fast that it essentially burns itself out, running through a population and infecting all the easy "marks" (people who have no immunity from vaccine or prior infection, aren't masking and are in close contact with others who aren't masking), and then finding itself fenced in. It's just a theory, and not anything to bank on, but based on the evidence from overseas, it does seem like Delta fades just as dramatically as it surges. And the metrics in Kansas this week are not nearly as bad as I feared they would be. 

The Good: Hospital ICU capacity statewide rose from 23% to 25%, according to the Kansas Hospital Association. The KC metro area was up from 17% to 21% and Wichita region was up from 19% to 20%. The only area of real concern was northeast Kansas (which I assume means everything other than KC — such as Lawrence, Topeka and maybe Leavenworth). There, ICU capacity was down to 15%. That's something to keep an eye on. Overall COVID hospitalizations statewide rose from 366 to 415, but I still take that as sort of a good sign. That's an increase of about 50 patients in a week, whereas the previous week we saw an increase of about 95. So the pace of new hospitalizations may be slowing, even if total hospitalizations are still rising.  

The Bad: The infection reproduction rate, Rt, in Kansas stayed at 1.2 this week. That means cases are still rising, but they aren't rising at a faster rate than they were the week before. I would love to see this number go down. As we all know by now, below 1.0 is where we want to be. 

The Ugly: Test positivity rose from 31% to 33.7%, according to Johns Hopkins. That's fourth-worst in the country behind Oklahoma, Mississippi and Alabama. It's not a huge increase, but it was pretty high to begin with.

Bonus: I have seen a disconcerting number of people on social media asserting that the vaccines "don't work" since the CDC issued its new guidance on masks. It's just not true, and if you want some evidence, look to Vermont. I have been checking the state health department's COVID-19 dashboard there regularly, because it's our most fully vaccinated state at nearly 70% of all residents (that's not just ELIGIBLE residents, that's everybody, including the kids who are too young to get the shot). The Delta variant has been present in Vermont since at least early June, but it has not had nearly the devastating effect there that it has had in Missouri. In fact, it's had almost no effect at all. Cases are up a bit, but hospitalizations have barely budged, fluctuating from about 3-5 people at any given time (yes, Vermont is a small state, but having only a few hospital beds in the ENTIRE STATE taken up by COVID patients is still amazing). And, get this: there has not been a single COVID death in Vermont for the last three weeks. Vaccines work. Even against the Delta variant, Vermont's high vaccination rate has succeeded in turning COVID, a disease that killed more than 500,000 Americans in a single year, into something akin to a common cold or flu. 

Kansas COVID-19 Update, Week 54

Everything looks worse this week, both statewide and in the Kansas City area specifically. The outbreak that incubated in Springfield has now fully moved here. Cases are up, hospitalizations are up, and even deaths are beginning to tick up again. KU Hospital, the biggest in the state, is feeling the pinch of capacity issues already. Our vaccination rate in KC is about 10 percentage points higher than Springfield, so we should expect our surge to plateau more quickly and at a lower level. But things still seem perilous right now. A couple months back I thought the danger of overwhelmed hospitals was past. But the Delta variant and the extreme slowdown in vaccinations have changed that.

The Bad: The least bad thing this week is the infection reproduction rate, Rt, which only went up from 1.1 to 1.2. Still not good, but at least it's not rising faster. The current outbreak will not plateau until we get the Rt down to 1.0. The most effective way to lower it is through vaccinations. After that, it's wearing masks and staying away from other people as much as possible. 

The Worse: As I sit down to write this, the KDHE dashboard for COVID-19 data seems to be down. Fortunately, the Kansas Hospital Association has updated its dashboard this week, for the first time in over a month. Hopefully there will be more updates to come, because these are numbers Kansans need to know. Adult ICU capacity is down to 23% statewide this week. Can't compare that to last week's 35% number, because that came from KDHE (which I believe also includes pediatric ICU beds). But here's a number we can compare: Total COVID hospitalizations statewide rose from 270 to 366 this week. ICU capacity is most strained in the Kansas City area (17% availability) and Wichita area (19%). That's bad because that's where the vast majority of ICU beds in the state are. Kansas City hospitals haven't seen this many COVID patients since last fall's surge. Obviously, Delta moves through a community very fast. Other regions should take note. 

The Ugly: Test positivity, as calculated by Johns Hopkins, rose from 26.5% to 31%. There's probably a lot more viral transmission out there than we're finding through testing right now, which would explain why hospitalizations are rising so quickly.  

Kansas COVID-19 Update, Week 53

Our months-long reprieve is over. New cases are still going up, and now hospitalizations are too. Missouri's COVID outbreak has come to Kansas, both directly (the surge in infections spilling over from southwest Missouri to southeast Kansas) and indirectly (the ripple effect of full hospitals sending patients to Kansas City). Our hospital capacity statewide is still in good shape, but the vaccination rate in Kansas is only nominally better than in Missouri. It's quite possible that some under-vaccinated areas of Kansas will be clobbered just as badly as Springfield, Mo., is now. The excellent science journalist Ed Yong recently wrote this piece about what it's like there. I recommend reading the whole thing, but this quote, from the medical director of CoxHealth, is perhaps the most important part for people who live in the KC area, where hospitalizations are up:  “Now we’re blasting (patients) outward,” Coulter said. “We’re already saturating the surrounding hospitals.”

The Good: The infection reproduction rate, or Rt, remained at 1.1. That qualifies as good news this week. It means that active cases are still rising, but they're not rising any faster than the week before. Of course, that depends on us testing enough to actually know how many cases there are. Which isn't happening. 

The Bad: Hospital ICU capacity fell from 37% to 35% this week, according to KDHE. But the really bad part is what's lurking behind those numbers. Total COVID hospitalizations rose from 143 on July 7 to 270 by July 14. Yes, that's almost double. We don't know yet how many of those people will eventually need ICU-level care, but certainly a chunk of them will. And cases in ICU are already up from 51 last week to 73 this week. Not good.

The Ugly: The precipitous rise in hospitalizations likely signals that we're missing a lot of cases at the pre-hospitalization phase, when they're pre-symptomatic or showing only mild symptoms. Because we're not testing enough. Test positivity rose from 23.8% to 26.5% this week, according to Johns Hopkins. That's going from bad to worse.

Bonus: The CDC warned this week that the COVID-19 vaccines are unlikely to work as well for people who are immunocompromised because of medical conditions or medications. This is logical, and the real-world data to back it up has been building for months now, but the CDC has been typically deliberate about making any definitive statements about it (which is not necessarily a bad thing — good science is often slow). What this means is that vaccination is not just a personal choice. If you choose not to be vaccinated, you're putting at risk people who are in cancer treatments, or have had organ transplants, even if they personally made a different choice. We need each other to beat the virus. Immunocompromised people are relying on the rest of us to get vaccinated, because it makes us far less likely to pass the virus to them. If you won't get vaccinated for your own benefit, please, PLEASE, consider doing it as a favor to your immunocompromised neighbors.     

Kansas COVID-19 Update, Week 52

 

COVID-19 continues to rage through Missouri, particularly in the southwest part of the state, where hospitals may be only a couple weeks away from having to turn away patients. New cases are clearly on the upswing in Kansas now as well. But we are not yet seeing a marked increase in hospitalizations. 

The Good: Hospital ICU capacity improved from 35% to 37% this week, according to KDHE. There were 143 total COVID hospitalizations as of July 7, including 51 in ICU. That's roughly in line with last week's numbers. 

The Bad: The infection reproduction rate, Rt, has risen from 1.0 to 1.1 this week. This was pretty much inevitable, given the rise in diagnosed cases. If the number of new cases is rising, then Rt will rise as well. The Rt rates in nearby states (1.3 in Oklahoma and Nebraska, 1.2 in Arkansas and Missouri) are also concerning. 

The Ugly: The test positivity rate in Kansas, as measured by Johns Hopkins, rocketed up again from 16.8% to 23.8% this week. That's the second straight dramatic increase and it means that even though we know that new cases are rising, we don't even have a good handle on how fast they're rising.   There have been anecdotal reports in the news about symptomatic people declining to be tested for COVID. That means a bigger share of the people who ARE being tested would be those who are hospitalized, which would obviously drive up test positivity rates. Declining to be tested if you have symptoms or know you've been exposed is not only bad for your own treatment plan, it's also grossly irresponsible to your family, friends and neighbors.

Kansas COVID-19 Update, Week 51

Hospitals generally see more burn victims on the 4th of July weekend. This year they're also seeing more COVID patients in Kansas. After several months of decline, new cases are now rising slowly, and so are hospitalizations and ICU admissions.

The Good: Hospital ICU capacity was 35% in Kansas as of the last day of June, according to KDHE. That's less than last week (37%), but still qualifies as the best news of the week. COVID-related hospitalizations are now hovering in the 140-150 range, after being in the 110-120 range in early June. And cases needing ICU are also beginning to rise, from down in the 30s in early June to the 50s now.    

The Bad: The infection reproduction rate, Rt, is now estimated at 1.0. That's the magic number at which active cases start going up again.

The Ugly: Test positivity jumped from 10.6% to 16.8%, according to Johns Hopkins. That's a substantial increase that once again makes Kansas the worst state in the country in this measure. Let's hope it's a data error. 

Bonus: COVID continues to rage in rural Missouri, and the effects are now being felt in Kansas City. Several area hospitals are now treating more COVID patients. They have the beds to handle it right now, but the rural hospitals that are sending them those patients are increasingly stressed, according to this doctor from KU Hospital:

 

Cases are going up in my hospital. Rural counties that send us patients have full hospitals with more than 90% of their cases Delta variant. I know it’s been a long time. I wish this was over, too. It’s not. :(

— Carla Keirns (@CarlaKeirns) July 4, 2021

 This will only get worse if current trends hold. 

Kansas COVID-19 Update, Week 50

Cases are still decreasing slightly in Kansas, but they're now rising in nearly all the surrounding states, including Missouri, which is now recording new case levels not seen since February. That will eventually have a spillover effect here. In fact, some border counties are already seeing slight increases, including Johnson County, which has more vaccine protection than most. The Delta variant is here, and those who are unvaccinated will be vulnerable.

The Good: The infection reproduction rate, Rt, dropped from 0.96 to 0.94. Always have to take this number with a grain of salt, because we've never done adequate testing. But it's good when Rt goes down. Here's the concerning part: look at this map. Missouri, Arkansas, Oklahoma and Nebraska all now have an Rt above 1.0, which means cases are increasing there. That's trouble for Kansas, especially during the summer travel season. 

The Bad: Hospital capacity fell a bit, from 39% to 37% this week, according to KDHE. That is still enough, but the number of patients hospitalized with COVID continues to climb, albeit slowly. The number in ICU does not seem to be rising proportionately lately, though, which is a good sign. Fewer infections are resulting in life-threatening illness.

The Ugly: Test positivity remained at 10.6%, according to Johns Hopkins. That's fourth-worst in the country, behind Arkansas, Idaho and Oklahoma (Missouri was fifth at 10.2%).

Bonus: An Associated Press analysis of data found that in May only about 1,200 of the country's 853,000 people hospitalized with COVID had been fully vaccinated (that's roughly 0.1%). Only 150 of the 18,000 Americans who died of COVID had been fully vaccinated (that's less than 1%). Hard to know for sure, but it's possible that all or nearly all of those 150 people were taking medications or had underlying medical conditions that made their immune systems less likely to mount a robust response to the vaccine. The vaccines are not foolproof, but they are nearly foolproof. Nearly everyone who is being hospitalized or dying from COVID right now is unvaccinated. That's it. That's the bottom line.  

Kansas COVID-19 Update, Week 49

It's a bit of an odd time in Kansas, as far as COVID goes. We seem to be pretty stable at about 100 new cases per day, which is manageable, but not ideal (ideal would obviously be moving toward zero at this point, like Vermont, where more than 80% of ALL residents are now vaccinated, and there are only TWO people hospitalized with COVID in the entire state). But test positivity is still high here, so we might be missing some cases, and  COVID hospitalizations have risen a bit of late. And then there's Missouri, which is looking more concerning by the day.

The Good: The infection reproduction rate, Rt, fell from 0.97 to 0.96 this week. That's good, but needs to be taken with a grain of salt, given the deficiencies in testing. A one-hundredth of a point difference could just be a function of undiagnosed cases.

The Bad: The Kansas Hospital Association didn't update its COVID dashboard this week, so I'll have to pull hospital data from KDHE. That data shows 39% ICU capacity available statewide, which is good. But it also shows slight increases (roughly 15%) in both COVID-related hospitalizations and ICU admissions last week. Not a good trend. Confirmed cases aren't going up, but hospitalizations are, which either means we're missing some cases, or the cases that are occurring now are more severe, and therefore more likely to require hospitalization (which could be the case if, as speculated, the new Delta variant that's now circulating causes a rougher form of the illness).

The Ugly: Test positivity fell from 11.2% to 10.6%, according to Johns Hopkins. But it went down more in other states. In fact, Kansas now has the highest rate in the country, at least as Johns Hopkins calculates it (some folks on social media have pointed out that the way that Hopkins calculates test positivity tends to result in a significantly higher rate than the way that state and local governments in Kansas calculate it. This is true. But it's still useful for comparing one state to another, and right now Kansas doesn't compare well). 

Bonus: Missouri is increasingly looking like a problem. Rural counties with low vaccination rates are encountering the Delta variant (and others) and the result is that new cases were up about 10% statewide last week, even as they kept plunging in metro areas like KC. The discrepancy here is not complicated: it's about vaccination rates. All things being equal, urban counties with much greater population density should be more susceptible to outbreaks than rural counties. But what we're seeing is the exact opposite. And that's because most urban and suburban counties have so far vaccinated a higher percentage of their residents. Unfortunately, the virus doesn't respect county lines, so the outbreaks happening in Missouri's low-vaccination areas are likely to spread, especially as we get into the heart of the summer travel season.