COVID-19 in Kansas, 03Dec2020
Kansas COVID-19 Updates
Yesterday we marked the one year anniversary of the first COVID-19 diagnosis in a patient. In that time scientists have isolated the virus, sequenced its genome and developed several vaccines, three of which are under consideration for emergency use authorization by the FDA. That’s pretty remarkable, an explosion of technology, science and commitment.
We’re going to talk about vaccines, how they work, and what to expect from these vaccines in the coming weeks. But because we have the latest edition of the White House Coronavirus Task Force (WHCTF) report to discuss, I’ll keep today’s vaccine discussion brief. Yesterday, the Advisory Committee on Immunization Practices recommended the following priorities for the first doses that will become available (see image below). The goal underpinning this recommendation appears to be preventing death and preserving hospital capacity by preventing staff shortages. Eventually, doses will likely be available to anyone who wants them, but we don’t have a timeline on when expanded eligibility will begin.
This week’s WHCTF report has stark warnings, not just for Kansas but nationally too. The language is the most direct I’ve seen in months. Special thanks to the Kansas Department of Health and Environment (KDHE) for supplying the report through an open records act request. You can read the report in its entirety here.
In case it’s hard to see/read those recommendations, we are in a very dangerous position right now due to strain on hospital capacity, impacting more than just COVID-19 care. If you are 65 or older or have underlying medical conditions, you need to effectively shelter in place and have groceries and medications delivered. If you are under 40 and attended a Thanksgiving gathering beyond your immediate household you need to assume you are infected and understand that you are a danger to others right now. Please self-quarantine and seek a test this week. Like I said, they’re very direct this week. But I think we need that leadership and guidance right now. I would be very careful about going into public, indoor spaces this week since those who got infected at Thanksgiving are infectious now. They may or may not realize they’re infected as they go out and about.
Below you will find the summary table from the WHCTF report. Kansas is in the red zone for every metric other than test rate per 100,000 residents. We’ll go through the specifics in the following sections.
Testing
Kansas is ranked #3 in the country for PCR percent positivity and the data collection for this week’s WHCTF was up to the day before Thanksgiving. So the impact of holiday laboratory closures and weekend effect is not impacting this metric, but will next week, with 4 of the 7 days being either weekend or holiday. For now, the Kansas percent positive rate decreased slightly in this week’s report, but remains above 20% meaning that one in every five people tested are positive. The Kansas positive rate is also more than twice as high as the national rate.
The high percent positive rate tells us that we aren’t testing widely enough to identify most cases. Cases that are missed go on to contribute to disease transmission in the community. If you look at our test rate per population, Kansas is trending in the wrong direction. As the pandemic expands you want to be doing more testing, not less. Instead, Kansas has noted a decrease in test rate of 42% in the past month. We are now testing at a rate that is 60.6% less than the national rate. You can’t find disease when you aren’t looking for it.
Cases
Kansas is ranked #9 in the country for new case rate per 100,000 according to the WHCTF, with data collected Saturday through Friday of last week. So this metric *is* impacted by one day of holiday closures. Increases in case rate was noted for both the state of Kansas and the nation as a whole. The case rate increased 8.1% for Kansas and the national rate increased 21.1%. Meanwhile, the Kansas case rate is 88% higher than the national rate.
Here’s a look at how they have color coded each of the state’s counties.
The number of counties on their list of counties of concern has increased dramatically over the past two months and now 92.3% of the state’s counties are in either the red, orange or yellow zones.
If we dig into the data from KDHE and look at how case rates vary across county types, we can see the trends in the graph below. The statewide average is represented by the black line.
It looks like cases have peaked and are starting to come down. However, I would expect that some of this decrease is an artifact of the holiday/weekend impact on test collection, processing and reporting. In any case, with Thanksgiving likely to be a high infection event, then we should brace for these decreases to reverse in the coming weeks, leading us right into Christmas when we risk repeating the cycle. The case rates are disproportionately higher in frontier and rural counties. Even densely-settled rural and semi-urban counties are above the state average, though. You can check to see your county’s classification here.
Hospitalizations
Hospital admissions dropped slightly in the past week and this data collection ended last Friday. We should note, however, that fewer hospitals reported last week, so that decrease may be artificial. In the past two weeks we’ve seen far more pediatric hospital admissions for COVID-19 than any other time that the WHCTF has been compiling the data.
Looking at the KDHE data, we are seeing about twice as many hospital admissions yesterday compared to Monday’s update (see graph below), which is interesting since it covered Friday - Sunday hospital admissions. So while cases might be decreasing, hospitalizations are increasing. The vast majority of those who are being hospitalized are above the age of 55.
Deaths
From the WHCTF report, the Kansas new death rate continues to move upward over time and we are ranked #18 in the US for this. The Kansas new death rate per 100,000 is 80% higher than the national average.
If we look more closely at the KDHE data and break down the deaths by county type, we see that same ebb and flow of the statewide death rate that the WHCTF notes (See black line) but also that the death rate is far worse in frontier and rural counties than anywhere else in the state. The death rate is lowest in densely-settled rural and semi-urban counties.
Many are expecting that we are going to see a surge upon a surge. By this, I mean that even as it seems cases are leveling (and maybe decreasing) for Kansas, the Thanksgiving holiday and those who gathered will drive cases up even further. In retrospect, the leveling we are observing now will look just like a small shoulder on the way up a much taller mountain. Christmas is three weeks away, by which time our hospitals, already strained pre-Thanksgiving, will be strained to the point of breaking down entirely. The CDC is advising that we all cancel our travel plans to gather for Christmas. I hope that we will do a better job of heeding that advice than we did for Thanksgiving.
References
https://www.coronavirus.kdheks.gov/160/COVID-19-in-Kansas
https://beta.documentcloud.org/documents/20418958-kansas-11_29_20
http://www.ipsr.ku.edu/ksdata/ksah/population/popden2.pdf
https://www.usatoday.com/story/travel/airline-news/2020/12/02/holiday-travel-cdc-says-dont-travel-christmas-new-years-hanukkah/3792632001/
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My Ph.D. is in Medical Microbiology and Immunology. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion and should not be considered medical advice.