Doctors at the University of Kansas Health System were cautiously optimistic on Tuesday morning.
COVID-19 positive inpatients at the KU Health System on Tuesday morning totaled 16 patients, up one since Monday, and seven in the intensive care unit, down one since Monday, according to Dr. Dana Hawkinson, medical director of infection prevention and control at the KU Health System. The hospital continues to have discharges and new admissions, he said at a news conference.
Dr. David Wild, vice president of performance improvement at KU Health System, said that at the hospital and county levels, they are beginning to see decreases in new cases. As time goes on, there will be more data to assess the situation and make predictions for the future based on what actually is happening rather than on models of what might happen, he said.
Dr. Ed Ellerbeck, chair of population health at KU Health System, said they have successfully bent the curve with the social distancing program. He mentioned his personal experience at seeing crowds out in public however; when he runs at the park, it’s now crowded and he tries to keep 15 feet away from others.
“Our infection rate is down quite a bit. But if you go back into history, we put the stay-at-home orders in Kansas on March 28,” he said. At that time, the state as a whole had 59 cases, and right now, the state is averaging around 150 cases a day, he said. There’s a lower rate in the metropolitan area now, having done a good job in lowering the rate.
“We’re back to where we were at the start of this, and as we loosen things up, we really could get a season’s spike of a couple months down the road,” Dr. Ellerbeck said.
Dr. Wild agreed that the lower numbers being seen currently are the result of what was done three or four weeks ago. They’re seeing the benefit of social distancing. As society reopens, there is a concern of some rise in the number of new cases, he said.
On the topic of hydroxychloroquine for COVID-19 cases, Dr. Hawkinson said some trials showed an improvement with it, but the best trials showed there was no improvement and some possible side effects such as arrhythmia or heart attacks in certain patients. There are trials ongoing on the preventive use of the medication among health care workers, and they are waiting for answers on these studies, he said.
Dr. Ellerbeck said some smaller rural communities are susceptible to COVID-19 outbreaks because it only takes one person who is infected to spread it and cause outbreaks.
Hotspots in rural Kansas are a problem, with one or two workers infected, then spreading it, he said. If a worker who tests positive in an industrial situation such as a meatpacking plant is at home with people who work in a nursing home, there could be concern about secondary spread, he added.
Dr. Wild said some counties are seeing only 2 to 3 percent rates of hospitalizations, which indicates a different population is being infected.
“We know in Wyandotte County when there were larger clusters in nursing homes, patients with co-existing disease and of an older age, there was a higher hospitalization rate,” Dr. Wild said. “Now that the majority of the new infections in Wyandotte County are in younger or not in clusters of nursing homes, there’s a slightly different hospitalization rate. Maybe different people getting infected than early on, or at least the clusters are in different places and a different demographic of the patient population.”
Also, they thought hospitalizations started seven to 10 days after infection, and now they know more about the asymptomatic days of infection, maybe it’s longer, possibly 12 to 14 days, he said. They might see an uptick, he added.
“Each county is behaving differently,” Dr. Wild said.
Dr. Ellerbeck said a 20 percent positivity rate seen locally and in the state suggests that they are still just testing the infected individuals. He was a little concerned they are still treating testing as a scarce resource. As they open up the community, they need to get a little more aggressive about testing individuals, he said. They need to be able to identify asymptomatic spreaders and get them isolated, he added.
The CDC is still focusing testing on symptomatic individuals, and testing will have to move beyond that, and where there are outbreaks, the asymptomatic contacts need to be tested quickly, he said.
The more they test, the more likely they are to find asymptomatic individuals, Dr. Wild said.
It’s important to look at Wyandotte and Johnson counties and understand what the decreasing positivity rate means in those counties, he said. Hospitals are testing patients admitted to the hospital, screening them for COVID-19 before surgeries or chemotherapy, he said. They have tested more asymptomatic people that they don’t expect to see a positive result, he added. That has changed the positivity rate in both counties, and probably showed a decreased incidence of disease, he said.
Also, he said they’re testing a little differently, so it’s difficult to compare the positivity rate now to the rate two months ago.
Even in the highest testing rate counties, they’ve maybe tested 2 to 2.5 percent of the population, Dr. Wild said.
Dr. Hawkinson said a recent study from the Journal of the American Medical Association looked at Los Angeles County, did random sampling and determined a 4 percent positivity rate to reach a possible figure of 365,000. It matters who is tested, and they should test as many people as possible to determine the dynamics of who is infected, according to Dr. Hawkinson.
Dr. Ellerbeck said probably closer to 98 percent of the people are still susceptible in this area. He said it only takes one case to get an outbreak going, so he wouldn’t be totally assured by low rates.
Some of the restrictions on people in the metropolitan area have loosened these past few days, although Wyandotte County remains in the “red zone” of its reopening plan.
Dr. Steve Stites, chief medical officer for the KU Health System, said he thinks COVID-19 is still out there significantly, and that two weeks from now, on June 1, they could get a better picture of it.
While some people may be going out as if things are back to normal, things aren’t back to normal, Dr. Stites said.
Dr. Wild said Kansas had the 23rd highest rate of COVID-19 infection in the United States, according to data per capita.
Density affects the ability to transmit COVID-19 and can be related to the length and duration of the exposure, according to Dr. Stites. Working and living conditions can be related to the amount of exposure.
Dr. Hawkinson said if people can maintain a further distance from each other, and a shorter time, it affects exposure.
A choir study of COVID-19 spread showed chairs were 20 to 30 inches apart and people were there for a couple of hours, Dr. Wild said. Greater closeness and longer time contributed to the spread of the disease.
Living conditions here that may affect the spread of COVID-19 include homes where not everybody has his own bedroom, according to Dr. Ellerbeck. There are multifamily living units, with a higher density of people living together. Also, some people have to take mass transit together. At meatpacking or processing plants, people are in closer contact with each other, he said.
Individuals living or working in those situations or using that kind of transportation are less likely to be wealthy and to be from under-represented minority communities, he said.
“They are bearing the brunt of this crisis,” Dr. Ellerbeck said.
Dr. Wild said a study of the Navajo nation found that one of the key features related to transmission was multigenerational family units. The nation had very low population density and a high rate of positive cases. They had 50 percent more per capita rate than compared with New York, according to Dr. Hawkinson.
The groups with the biggest health disparities also are the workers most important to society, including the first-line workers and supply-chain drivers, Dr. Hawkinson said.
Dr. Ellerbeck said keeping the workplace safe will mean social distancing and wearing masks to protect the people around you. He worried that some people will try to act “tough” and not wear a mask, but a mask protects others, he said.
Dr. Hawkinson recommended wearing a mask in public, including if getting a haircut or other personal services. He recommended not going if you are ill or if the provider is ill. Those who receive personal services should use hand sanitizer when coming in and going out of a hair salon or other business, he said. The 20 to 25 minutes spent there and the close proximity to another person means a very high risk, he added.
Dr. Ellerbeck recommended that parents get their children in for routine checkups and for scheduled immunizations.
Dr. Hawkinson said it would be tragic if kids didn’t get their regularly scheduled vaccines for mumps, measles and other diseases and were to get those diseases, and possibly COVID-19 as well.
Dr. Stites asked people to continue their good hygiene practices until a COVID-19 vaccine is available, which he thinks is not that far away, perhaps five months.
Wyandotte County reported 1,173 positive COVID-19 cases at 11:20 a.m. May 19, an increase of 10 since 8:30 a.m. May 18, according to the Unified Government Health Department’s COVID-19 webpage. There were no new deaths reported at 11:20 a.m., with the same total number, 70, as on May 18.
Hospitalizations were reported at the same number, 30, as on May 18, with recoveries at 365, an increase of 10, according to the UG COVID-19 webpage.
Testing continues Tuesday in Wyandotte County
According to the UG’s COVID-19 hub, testing locations for COVID-19 include:
• 1 to 5 p.m. Monday through Friday at the UG Health Department parking lot, 619 Ann Ave., Kansas City, Kansas.
• 9:30 a.m. to 4 p.m. Monday through Friday at Swope Health, 21 N. 12th St., Suite 400, Kansas City, Kansas. Call 816-923-5800 to schedule an appointment.
Several pop-up testing sites are planned this week. Wyandotte County residents may call 913-371-9298 to register for a test.
Tuesday’s pop-up location:
• 2 to 6 p.m. Tuesday, May 19, Turner Recreation Commission, 831 S. 55th St., Kansas City, Kansas.
Wednesday’s pop-up location:
• 10 a.m. to 2 p.m. Wednesday, May 20, at KC Community Church, 5901 Leavenworth Road, Kansas City, Kansas.
The KU doctors’ news conference is online at https://www.facebook.com/kuhospital/videos/178852030076374/.
More information about the “red zone” rules is online at the ReStart WyCo hub at https://wyandotte-county-covid-19-hub-unifiedgov.hub.arcgis.com/pages/restartwyco.
The ReStart WyCo plan is at https://www.wycokck.org/WycoKCK/media/Health-Department/Documents/Communicable%20Disease/COVID19/RestartWYCOGuidanceDocument043020.pdf.
The UG’s COVID-19 webpage is at https://alpha.wycokck.org/Coronavirus-COVID-19-Information.
The Kansas COVID-19 website is at https://covid.ks.gov/.
The Kansas COVID-19 resource page is at https://govstatus.egov.com/coronavirus.
Information from the CDC is at https://www.cdc.gov/coronavirus/2019-nCoV/.
The number of positive COVID-19 cases in the Kansas City metro area is listed at a website sponsored by the Mid-America Regional Council at http://marc-gis.maps.arcgis.com/apps/opsdashboard/index.html#/1c93961075454558b3bf0dfad014feae.