The Week in Context, 08Oct2020
Kansas COVID-19 Updates
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, we’ll dig a little deeper into the Kansas data.
The World
Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >36.2 million people and killed 1,056,300 as of this morning.
The US is a warm spot (not red hot as before), as is much of the Western hemisphere. Canada moved up into a higher color category this week. We are ranked 26th in the world for weekly case rate. Our weekly case rate per 100,000 is 96. Some of the hottest areas in the world for disease right now are in Europe, the Middle East and the Western Hemisphere.
For deaths, our weekly death rate per 100,000 decreased slightly to 1.5 (down from 1.6 last week) and we are ranked #28 in the world for this. The top five countries for death rates per 100,000 this week are Argentina, Kosovo, Aruba, Montenegro, and Israel.
The United States
As hot spots go, they are mainly concentrated throughout the Midwest and much of Wisconsin is bright red. As of this morning, there have been over 7.5 million cases and 211,750 deaths in the US. Keep in mind that both of these numbers are probably an under-count of the situation in our country. That’s because it took a long time for us to build test capacity in the early stages of the pandemic and an estimated 40% of cases are asymptomatic and may not seek a test.
Missouri and Kansas are ranked #10 and 16 in the nation, respectively, for 7-day case rate per 100,000. The Kansas case rate is 142 per 100,000 in the past 7 days compared to the national average of 96. In other words, Kansas has a disease rate that is 48% higher than the US average. The top ten states in the US include six Midwestern states.
Kansas has no counties in the top 20 counties in the nation list for cases per 100,000 in the past week, but Sheridan county is ranked #21. St. Joseph, Missouri, right on the border of the two states, is the #18 city in the nation for average daily case rate (54.4 per 100,000 in the past two weeks).
Kansas
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 16 counties that are green or yellow. In other words, 85% 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. We’ll look more closely at how disease rate compares across different county types in the next update.
I was able to gather all of the White House Coronavirus Task Force (WHCTF) reports for Kansas since the start of the pandemic through a Kansas Open Records Act request. You can see many of them at the Center for Public Integrity. While it’s best to look at local data whenever possible, these reports help us to see what the scientists on the WHCTF were tracking for Kansas, the recommendations they were making to our leadership, etc. It also allows us to compare Kansas trends to the US. The first graph I’m showing that is based on data from these reports is below, depicting case rate per 100,000 people.
For much of the pandemic, Kansas has been below the national average. But that changed in mid-August and we have been above the national average ever since. Unfortunately, our rate is climbing. Next, let’s look at how the counties that are on the WHCTF radar as counties of concern have varied over time. The black line shows the combined total for the state.
Overall, the number of counties on the WHCTF list of counties of concern has increased by 80% since the beginning of August.
According to the CDC, Kansas has a cumulative test rate of 29,601 per 100,000 residents and we are ranked 30th in the nation for this. If we look at percent positive rate using the map below, you can see that most of the Midwest is in the second highest tier, representing 6-10%. Percent positive rate can give us an estimate as to whether we’re doing enough testing. Ideally, we want to be at or below 5% for a sustained period of time. This sounds like a big waste of time, money and resources. But as the adage goes, an ounce of prevention is worth a pound of cure. If we know where the cases are, public health officials can advise them to isolate and quarantine their close contacts, to prevent disease spread throughout the community. The higher the percent positive rate, the more testing might be needed. Again, this CDC map is depicting cumulative information, not recent. Note that the CDC does not provide data on rapid antigen test results. Kansas does include rapid antigen test results in their case totals.
To look at more recent testing data, we have to go back to the New York Times resource. In the past two weeks, it notes that Kansas has an average daily test rate of 138 tests per 100,000 and it is ranked 43rd in the nation for this. Together with the Harvard Global Health Institute, they estimate that Kansas is performing at 20% of the ideal testing target. The ideal testing target is based on local disease rates. In the graph below, you can see how Kansas (blue line) compares to the United States (red line) for test rate per population. The data for this graph come from the White House Coronavirus Task Force reports for the state of Kansas.
So the estimate that Kansas is only performing at 20% of the ideal testing target may have to do with the drop in testing we saw in the previous week. Apart from that, we’ve been very close to the national average for much of the past three months. The next graph shows us the percent positive rate for RT-PCR tests (the gold standard for identifying COVID-19 cases).
The national rate has steadily declined since a peak in mid-July. However, the state of Kansas has not enjoyed such a rapid descent. Our rate has stayed very high compared to the national average.
The US Department of Health and Human Services indicates that in Kansas, 4.74% of all hospitalized patients are there for COVID-19, either confirmed or suspected. Using data from the White House Coronavirus Task Force reports, we can see how COVID-hospitalizations (both confirmed and suspected) have varied over time across the state. For this graph, the hospitalizations (red and blue lines) correspond to the left y-axis and the gray line (percent of hospitals reporting) corresponds to the right y-axis.
Reporting has improved greatly over time. Hospitalizations have been relatively stable over the summer, but there has been greater variability in the past month.
An area with high vulnerability to COVID-19 outbreaks is skilled nursing facilities. In the graph below, you can see how these settings have been impacted by COVID-19 each week, over time.
Since the WHCTF began producing these reports, Kansas has been well below the national average for skilled nursing facilities with at least one case. But that rate has been increasing and now we have intersected with the national average. It’s a worrying trend given how medically vulnerable many of the patients in these facilities are.
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. For whatever reason, there was a spike during the week of 9/20, but it has since receded. Kansas is ranked #17 in the nation with 1.6 deaths per 100,000 residents in the past week, according to the data tracker at the New York Times.
I’d like to introduce a new resource as we head into influenza season. This is FluView, a helpful tool that CDC has produced for a long time. 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.
You’ll notice that we don’t get data more specific than state level, so you could have a situation where influenza is really bad in one city and as a consequence, the whole state appears red, for example. That’s not the case now, but I want to go over how to read and interpret the map. For now, there is only one US territory with moderate influenza-like illness and that’s Puerto Rico. There is slightly more influenza-like illness activity in Idaho and Missouri than the rest of the country, but all of the continental US is in the minimal category for now. I’ll be sure to include this map in future weekly posts since COVID-19 and seasonal influenza share so many symptoms in common.
Speaking of similar symptoms, I’ve gathered the symptoms for each condition from the CDC websites. When in doubt, seek a test. Because there are *many* similarities between COVID-19 and influenza.
References
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
https://khn.org/news/lack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic/
https://protect-public.hhs.gov/pages/hospital-capacity
https://globalepidemics.org/key-metrics-for-covid-suppression/
https://covid.cdc.gov/covid-data-tracker/#testing_testsper100k
https://www.cdc.gov/flu/weekly/index.htm
https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-seasonal-allergies-faqs.html
https://protect-public.hhs.gov/pages/hospital-capacity
https://publicintegrity.org/health/coronavirus-and-inequality/white-house-coronavirus-red-zone-reports-covid/
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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.