As Wyandotte County entered Phase 3 of the reopening plan, doctors at the University of Kansas Health System discussed why positive case numbers are going up but hospitalizations are generally down.
Hospitalizations of COVID-19 patients at KU Health System have been reduced in the past few weeks.
Dr. David Wild, vice president of performance improvement at KU Health System, said there is an increase in the rate of new COVID-19 cases in the metropolitan area and across Kansas.
“That is sort of contradictory to the number of patients we’re seeing in the hospital,” he said.
The number of COVID-19 patients in the hospital is a function of a couple of factors, including the number of new cases, and as that number goes up, there are more people in the hospital, he said. Also, as the number goes up, the number also reflects how long the people are staying in the hospital. Those who don’t need intensive care and ventilators are there only for a few days, while those who need critical care are there longer, he said.
As the number of people who are really critically ill has gone down, so has the number of people in the hospital, he said. It’s probably mostly because those coming to the hospital are younger and don’t have as much co-existing disease, he said. That’s related to the fact that they are not seeing a large number of new nursing home outbreaks, and also that they are picking up patients who are being screened. For example, two positive tests were found when screening patients who were admitted to the hospital for other reasons recently, he said. The trend is pretty consistent in most places, he said.
It’s a combination of those things, but probably most related to the age of people, according to Dr. Wild.
Dr. Dana Hawkinson, medical director of infection prevention and control, said there have been some reports from Italy about the possibility of the virus shifting and being milder, but there has been no clinically significant strain change. The virus is still out there, he said. There have been some single mutations but there is no
Initially, in China they thought 2 to 3.5 percent of the population might be asymptomatic, and other doctors now are wondering if that number was actually higher. Reports here are saying about 30 to 40 percent of people in the United States were asymptomatic, he said.
Dr. Wild said the 40 percent was true at the time of testing, but perhaps some were pre-symptomatic.
Dr. Hawkinson said while duration of exposure is important, with more risk of coming into contact to the virus, but in theory, it takes just one viral particle to infect a person. Winter and cooler seasons are typically worse for viruses, and duration in confined spaces is important.
Dr. Wild said large numbers of tests, for example, at meatpacking plants, that impacts the numbers. Over the course of time, since late May, the trend of percent positive is up, he said. For example, at the hospital Sunday, 109 tests were run, with 4.6 percent, or five cases, positive. For many weeks, the percentage was less than 1 percent, he added, and they are testing the same way now as previously.
“That trend is the same in most places,” he said. He doesn’t think the general population rate is as high as 5 percent positive.
When the disease started, they didn’t know how it worked, he said. They received information from China and Italy, and thought the greater the physical distance, the more they could reduce the spread of the disease. Early, there were predictions of 2 to 11 percent hospitalizations from China and Italy. They had models for emergency preparedness of 2, 4 and 5 percent hospitalizations, he said. It has been pretty close to across the state, although higher in Wyandotte County, but they expected that based on age, co-existing disease, access to health care and other factors, he added.
As they look forward and forecast what they think will happen in the next two, three or four weeks, they’re using a smaller hospitalization rate, more consistent with what they’re seeing, he said. He thinks it’s good the number is declining. They’re not currently forecasting the hospital being overrun with cases, he said, although there may be some increase in the next few months.
Dr. Hawkinson said they’ve been extremely lucky here, after seeing what happened in New York and other states. They have prepared for a surge, and hope it doesn’t happen, he added.
Dr. Wild said they originally thought they might see a peak of new infections two weeks or 14 days after exposure. What they are actually seeing in the data is increases resulting from some party, or decreases resulting from an intervention such as a stay-at-home order, are starting to have an impact three weeks later on new cases and peak at four weeks. Hospitalizations are peaking at five weeks and deaths are peaking at six or seven weeks, he said. He added that’s true in the hospital’s data, in the 14-county metro area and in the state of Kansas.
Just from that perspective, it’s too early to know if there will be cases resulting from the Lake of the Ozarks parties, Dr. Wild said.
“What we’re seeing right now is really related to Mother’s Day,” Dr. Wild said. “What we’ll see next week is related to Memorial Day. And two weeks from now will be related to the protests and demonstrations.”
The “next normal” will change, he said. He expects a small increase, but he doesn’t know how many, in the next week or two.
Dr. Wild said many of the interventions have worked to reduce the spread of COVID-19. There is a national plateau of more than 20,000 new cases a day for about 40 days, he said. It is a stable number for new cases, he added.
He said if they can continue to isolate nursing home populations well, it is not likely to result in large numbers of hospitalizations and deaths.
Wyandotte County has allowed swimming pools to reopen today, although the Unified Government’s only public swimming pool, Parkwood, will remain closed. Pools such as hotel pools, backyard pools and Turner Recreation’s pool may reopen under Phase 3. Dr. Hawkinson said people should continue to maintain 6 to 10 feet of distance if they can. They are not worried about the virus droplets getting into the pool, but more about the closeness of people to each other.
While people have gotten sick from being in gatherings outside, they are safer outside than inside an enclosed space, according to Dr. Hawkinson.
“We’re going to learn a lot about intensity of exposure as well as if you’re inside or outside. I think we’re going to learn outside is better,” Dr. Stites said. “I’m not saying go to Arrowhead Stadium yet.”
Dr. Hawkinson said it was important for people to wear masks. In a recent case in Missouri, when both hairstylists and clients were wearing masks, the initial testing didn’t turn up any positive cases.
Dr. Wild said there has been much discussion recently about what percentage of those who are positive are super-spreaders of the virus. He said it’s not related to a change in the virus or whether there is a different strain or whether it’s getting more or less infectious, but it is the behavior of people that’s leading to more people getting infected.
“It’s important for us to realize there are a number of things we can do to reduce spread,” Dr. Wild said. “It’s not only staying in your home or keeping 6 feet.”
Dr. Hawkinson said wearing a mask is especially important when people are closer than 6 to 10 feet away from others, and other factors include how long they will be around others. If people are not in confined spaces, if they are outdoors away from others, the risk is very minimal, he said. The more to distance from other people, then the less they need a mask. When going into a store, a mask is important, he said.
Dr. Wild said that in some meatpacking plants, the workers were wearing masks at the point of the outbreak, but some of them were not wearing the masks properly. Some persons pulled their masks below their nose, covering the mouth and not the nose, he said. Whenever he sees someone wearing a mask like that, he stops and tells them to cover both the mouth and the nose, he added.
Dr. Hawkinson recommended that people get their flu shots this fall, as well as social distancing, continuing hand hygiene and wearing masks.
Johnson County has been reported an increase of COVID-19 positive patients in the intensive care unit. Dr. Wild said it is related to other things, as well, including patients in the hospital for other conditions.
Dr. Stites said they are not seeing a surge right now, and that they have opened up other procedures knowing they have personal protective equipment, flexibility and capacity. The closing gave hospitals the potential to build up their personal protective equipment and to work on what their plans would be.
KU Health System had nine COVID-19 patients over the weekend, and 11 on Monday morning, Dr. Hawkinson said. That included six in the intensive care unit and two on ventilators. There were two deaths over the weekend, he said.
Wyandotte County reported 1,502 positive cases at 11:30 a.m. Monday, as compared to 1,496 cases at 1 p.m. Sunday. There was an increase of six cases since Sunday.
The KU doctors’ news conference is online at https://www.facebook.com/kuhospital/videos/552088238822078/?v=552088238822078.
The UG’s COVID-19 information page is at https://alpha.wycokck.org/Coronavirus-COVID-19-Information.
Wyandotte County is currently under Phase 3. See covid.ks.gov.
The state plan’s frequently asked questions page is at https://covid.ks.gov/wp-content/uploads/2020/05/Reopening-FAQ_5.19.2020_Final.pdf.
Test sites are listed at https://wyandotte-county-covid-19-hub-unifiedgov.hub.arcgis.com/pages/what-to-do-if-you-think-you-have-covid-19.
The CDC’s COVID-19 web page is at https://www.cdc.gov/coronavirus/2019-nCoV/index.html.