The Week in Context 13Oct2020
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 > 37.9 million people and killed 1,081,800 as of this morning. Both of these statistics are likely to be undercounts because of how many cases are asymptomatic and problems with testing and reporting disease throughout the world.
The US has rejoined the ranks of the hottest countries in the world for COVID-19 cases after several weeks in the second tier. There are many counties in the Western hemisphere that share this distinction. We are ranked 25th in the world for weekly case rate over the past 7 days. Our weekly case rate per 100,000 is 105 (up from 92). The top five countries for case rate per 100,000 in the past week are Andorra, Czech Republic, Belgium, Montenegro, and Israel.
For deaths, our weekly death rate per 100,000 remains at 1.5 and we are ranked #27 in the world for this (down from #20 last week). So 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 Kosovo, Argentina, Montenegro, Ecuador, and Israel.
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. As of this morning, there have been over 7.8 million cases and 215,190 deaths in the US. Keep in mind that both of these numbers are probably an under-count of the situation in our country.
Kansas and Missouri are ranked #14 and 16 in the nation, respectively, for 7-day case rate per 100,000. The Kansas case rate is 183 (up from 142 last week) per 100,000 in the past 7 days compared to the national average of 105. In other words, Kansas has a disease rate that is 74% higher than the US average. The top ten states in the US include six Midwestern or Plains states.
Kansas has three counties in the top 20 counties in the nation list for cases per 100,000 in the past week. They are Norton (#3, 2332 cases per 100,000 past 7 days), Sheridan (#11, 1428 cases per 100,000), and Sherman (#14, 1268 cases per 100,000). These counties are all in the northwest corner of the state.
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 13 counties that are green or yellow; last week there were 16. In other words, 88% 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.
I want to introduce you to a helpful tool that can help you to assess risk in your local community, at even finer detail than the maps provided by the Harvard Global Health Institute. This tool comes from Georgia Institute of Technology and it’s a risk assessment tool to predict the likelihood that someone will be COVID-positive at a social gathering in your county of interest. To start, choose your event size (see the slider in the lower left. I’ve chosen a 25 person gathering for this example. Then choose your ascertainment bias (also in the bottom left of the image below). This ascertainment bias acknowledges that we probably are not identifying all the cases that are out there because of asymptomatic cases or test seeking behavior by members of the public. You can choose the low end estimate that there are 5 times more cases than we currently realize or the high end estimate that there are 10 times more cases. For this example, I’ve chosen the low end bias (ascertainment bias = 5). But I’d encourage you to do both to know both estimates. Once you’ve chosen those two things, it’s time to zoom in to Kansas and choose a county of interest. I’ve chosen Shawnee county for this example.
For this example, when I choose a 25 person gathering and an ascertainment bias of 5, it tells me that there is a 20% risk that someone at my event will be positive (or 1 in 5). If I choose the high end estimate (10 times more disease than we currently realize), then the risk is 36%. Let’s say we choose the top county for disease rate in Kansas (Norton). The risk of someone being positive at a 25 person event there is 91-99%. If you practice with this tool, you’ll notice that the larger your event size, the more likely someone is to be positive. So this is a good reason to keep your social gatherings as small as possible and avoid any unnecessary risk.
In the past two weeks, Kansas has an average daily test rate of 142 tests per 100,000 (up from 138 last week) and it is ranked 42nd in the nation for this (up from #43 last week). Together with the Harvard Global Health Institute, they estimate that Kansas is performing at 19% 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 16%. Meanwhile, the goal set by the World Health Organization is to be at or below 5% for a sustained period of time.
The US Department of Health and Human Services indicates that in Kansas, 5.76% of all hospitalized patients are there for COVID-19, either confirmed or suspected. This is an increase compared to the 4.74% reported last week.
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, both Missouri and Kansas are now in the top 10 states for death rate per 100,000 in the past week, ranked #4 and #10, respectively. Missouri’s death rate is 4.2 per 100,000 and the Kansas death rate is 2.3 per 100,000. Meanwhile, the national average is 1.5 per 100,000. In other words, the Missouri death rate is 180% higher than the national average and the Kansas death rate is 53% higher than the national average, according to the data tracker at the New York Times.
Because influenza season is about to begin and it shares so many similarities with COVID-19, here’s an updated look at FluView from CDC.. 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 moved into the yellow (low) zone, Puerto Rico dropped back into minimal levels. Oregon, North Dakota and Kentucky saw increases too. Kansas remains in the most minimal of the minimal section. 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.
The last thing I want to discuss today is voting in the 2020 election and how to do it safely during the pandemic. I DO NOT want the pandemic to stand in the way of you casting your ballot. We just need to plan ahead and be prepared. As with many things, each person and each family will need to weigh their own risk. First, today is the last day to register to vote in Kansas and you can do so online. It takes about five minutes. You can also check your voter registration here. I would recommend looking at a sample ballot and considering the issues or candidates on the ballot before you head to the polls, so that your time in the voting booth is as brief as possible. You can look up sample ballots when you check your voter registration information and you can learn more about the candidates and local referendums by visiting Ballotpedia, which is like the Wikipedia of elections.
Lowest risk: vote by absentee ballot. You can request your ballot here. This method of voting involves the least amount of exposure to others. You can fill out and mail your ballot once you’re finished or drop it off at the county elections office.
Moderate risk: vote early in person. This option begins in some areas on Wednesday, October 14th. Check with your local election office to verify dates and times for early voting in your area. This option is “moderate risk” because on most days the crowds will be smaller than on Election Day. But be prepared to wait, just in case. Be sure to wear a mask and keep 6 feet of separation with others, especially when you’re indoors. Take advantage of handwashing or hand sanitizing opportunities as they’re available. Consider carrying your own hand sanitizer, just in case.
Highest risk: vote on Election Day. The same precautions I recommended for voting early apply here too. The difference is that there may be greater crowds on Election Day than during the early voting period. If you are a person who has difficulty standing in line, it might be advisable to bring a small folding chair. But think ahead about how you are going to manage risk for possibly an extended period of time.
I’m not at all concerned with who you vote for, but want to encourage you to vote in the safest way possible for your needs. As with everything else during the pandemic, voting is more of a challenge than in years past. But with some pre-planning and risk mitigation, it can still be done.
References
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
https://protect-public.hhs.gov/pages/hospital-capacity
https://globalepidemics.org/key-metrics-for-covid-suppression/
https://www.cdc.gov/flu/weekly/index.htm
https://www.who.int/publications/i/item/public-health-criteria-to-adjust-public-health-and-social-measures-in-the-context-of-COVID-19
https://covid19risk.biosci.gatech.edu/
https://www.kdor.ks.gov/Apps/VoterReg/Default.aspx
https://myvoteinfo.voteks.org/VoterView
https://ballotpedia.org/Main_Page
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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.