Hello readers! Today I’ll focus on how the situation in Kansas fits into the national context and how the US fits into the global context. Next time, I expect to go over the most recent White House Coronavirus Task Force report and some Kansas-specific data from the state.
Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened > 37.6 million people (+2.5 million since last week) and killed 1,114,100 (+36,600 in the past week) as of this morning. The US accounts for 20.4% of global cases and 19.7% of global deaths.
The US has rejoined the ranks of the hottest countries in the world for COVID-19 cases per population after several weeks in the second tier. Argentina and Panama are other counties in the Western hemisphere that share this distinction. Things are intensifying quickly in Europe. We are ranked 36th in the world for weekly case rate over the past 7 days (last week, 25th). Our weekly case rate per 100,000 is 119 (up from 105). So as our case rate increases, we slide down in the rankings - this is not an indication that the US is doing well, but rather that other countries are doing much worse. The top five countries for case rate per 100,000 in the past week are Andorra, Czech Republic, Belgium, Netherlands, and Luxembourg.
For deaths, our weekly death rate per 100,000 remains at 1.5 and we are ranked #32 in the world for this (down from #27 last week). Again, the fact that our death rate held steady but our ranking declined tells you how much deaths are increasing in other parts of the world. The top five countries for death rates per 100,000 this week are Montenegro, Argentina, Andorra, Czech Republic, and Bahamas.
The United States
As hot spots go, they didn’t move that much this week but got more intense. They are mainly concentrated throughout the Midwest and much of Wisconsin is bright red. Minnesota has new hot spots compared to last week. As of this morning, there have been over 8.1 million cases and 219,541 deaths in the US. Keep in mind that both of these numbers are probably an under-count of the situation in our country.
Cases: Kansas is ranked #15 in the nation for 7-day case rate per 100,000, an increase from #16 last week. Our case rate is 188 per 100,000 in the past 7 days (up from 183 last week). The Kansas case rate is 58% higher than the national average. Of the top 10 states for 7-day case rate per 100,000, half are in the plains states or Midwest.
Kansas has two counties in the top 20 counties in the nation list for cases per 100,000 in the past week. They are Sheridan (#3, 1904 cases per 100,000 past 7 days) and Norton (#13, 1268 cases per 100,000). These counties are both in the northwest corner of the state. Kansas has no cities in the top 20 cities in America for case rate per 100,000.
Testing: In the past two weeks, Kansas has an average daily test rate of 142 tests per 100,000, the same as last week. This week, Kansas is ranked 44th in the nation for test rate (down from #42 last week). Together with the Harvard Global Health Institute, the New York Times estimates that Kansas is performing at 17% of the ideal testing target. The ideal testing target is based on local disease rates. In that same time, the Kansas percent positive rate has been 17%. Meanwhile, the goal set by the World Health Organization is to be at or below 5% for a sustained period of time. When you have a percent positive rate higher than 5%, it indicates you probably are missing cases with your existing test strategy and need to scale up.
Hospitalizations: The US Department of Health and Human Services indicates that in Kansas, 5.86% of all hospitalized patients are there for COVID-19, either confirmed or suspected. This is an increase compared to the 5.76% reported last week. While 5.86% doesn’t sound like a big number, there are hospitals in the Kansas City metro that are full and having to turn patients away.
The top three states in the nation for this metric are North Dakota, Mississippi and Wisconsin. These data come from the Health and Human Services dashboard which was last updated on 13Oct.
Earlier this month, the CDC updated their list of underlying conditions that might contribute to more severe COVID-19 disease. The two changes are listed in red. Smoking moved from the mixed evidence to strongest evidence column. Being overweight (but not obese) joined the list in the limited evidence column.
Deaths: As our cases per 100,000 have increased, we are also seeing an increase in our deaths per 100,000 in the past 7 days. In fact, Kansas is ranked #5 in the US for death rate per population. The recent Kansas death rate increased this week from 2.3 to 3.1 per 100,000. Meanwhile, the national average is 1.5 per 100,000. In other words, the Kansas death rate is more than twice as high as the national average.
Influenza: Here’s the latest look at FluView, showing how influenza-like illness compares across states. The map below depicts how states compare when considering the average percent of outpatient (meaning, not warranting a hospital admission) visits for influenza-like illness for the current week compared to non-influenza season weeks.
The changes compared to last week is that Iowa intensified into the moderate activity zone, joined by West Virginia. North Dakota dropped back into the lowest minimal category. Minnesota, North Carolina, and New Mexico jumped up slightly in the minimal category. Kansas remains in the most minimal of the minimal section, but our neighboring state of Missouri is coded a lighter shade of green. Keep in mind that influenza is not a mandatory notifiable disease for public health departments like COVID-19 is. But there is a robust surveillance network for tracking trends. So we aren’t likely to see case counts and death counts like we do for COVID-19 because we are seeing estimates for influenza rather than actual numbers. Both diseases feature a wide spectrum of disease severity that can make it hard to identify all cases. You can read the weekly report from Kansas Department of Public Health here.
Here is how the state of Kansas is looking based on the risk tool from the Harvard Global Health Institute. The color coding is explained below the map. In short, green is good, red is bad.
There are just 12 counties that are green or yellow; last week there were 13. In other words, 89% of the state’s counties are in the red or orange categories. Many of the red counties are concentrated in the western half of the state where population densities are smaller. But this week, there is more intensity in the southeastern corner of the state as well.
This next graph is based on data that are provided in the Kansas Department of Health and Environment Coronavirus data hub in the cluster summary tab. For today’s purposes, I wanted to look deeper at the clusters that have the most severe outcome (death) and these are the top four, ranked long term care facilities, meat packing plants, religious gatherings and corrections facilities.
Long term care facilities are associated with a lot of clusters, but relatively few cases per cluster (14.7). However, those few cases result in the highest death rate per cluster (1.69). That’s maybe not new information, we’ve known for much of the pandemic that LTCFs were a real point of vulnerability. The setting with the next highest death rate per cluster is meat packing plants. Unlike LTCF clusters, there are relatively few clusters at meat packing facilities. But when they do happen, the cases spread like wildfire. This group has the highest hospitalization rate of any clusters that the state has tracked. The third highest death rate per cluster is associated with religious gatherings. On average, each one is resulting in about 11 cases and their hospitalization rate is second only to meat packing plant-associated clusters…so even higher than that associated with LTCFs. The fourth highest death rate for a cluster setting is associated with correctional facilities. Their data look similar to the meat packing plants - relatively few clusters but when they happen they average a large number of cases. That’s probably not surprising considering that the facilities are often overcrowding and social distancing is harder to achieve. Of the four cluster settings discussed here, they have the lowest rate of hospitalizations and deaths.
In total, today there was a net increase of 2113 cases since the Friday report and the new statewide total is 72,968. There was a total of 143 tests reported today and, of those, 6.3% were positive. This is a low yield day, an example of weekend effect. Since the majority of tests are being performed at commercial laboratories and they don’t work at maximal capacity on the weekends, test output tends to dip on the weekends. There was a net increase of 51 hospital admissions and 13 deaths. The updated death total is 872, for a case fatality rate of 1.2%.
To summarize, Kansas is in a rough spot right now. Regionally, we aren’t alone in this. The map shown below from COVID Exit Strategy explains what I mean. The vast majority of the country is either trending poorly or showing uncontrolled spread of the disease.
But there are still things we can do to improve our situation. Be a hero in your community today and wear your mask, keep 6-12 feet of distance, practice good hand and cough hygiene, avoid unnecessary interactions with others, etc.
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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.