Training Through Covid-19 – November 2020 Update

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​What we’ve seen in the past two weeks is very interesting - we’ve seen ​20% of the total cases ever reported in Johnson County in the past two weeks - total reported since March, the beginning of this pandemic. With that many cases, there is not corresponding evidence of serious disease in terms of hospitalizations in Johnson County, which are staying steady at ​under three (3) new hospitalizations per day.

​One of the hard things to understand in all of this is what an “infection” or a case really means. Common sense tells us that a “case” involves a chief complaint - or reason for visit in a doctor's office. A case, historically, has involved some evidence of disease, at which point a COVID diagnostic test is done and interpreted by a clinician.

It’s really easy to get lost in the sauce with the jargon and the different ways the words have been used over time, and the way our goals and expectations have been changed in terms of managing COVID.

In the public’s mind, testing positive on a PCR or antigen rapid test equates to being ill or being able to pass on the virus. This is not necessarily the case and testing has to be done with the right cycle threshold on the PCR test. Testing should be part of a clinical diagnosis by a doctor.

Currently, cases do not directly map to illness or the spread of serious illness to the degree presented to the public. The public is also concluding that asymptomatic individuals have a high enough viral load to be spreading disease, and everyone is "sick until proven well." This hypothesis remains to be proven.

​2 - How many people are getting really sick with COVID-19? (Really sick people are put in the hospital)

Case and infection rates are rising, hospitalizations are rising somewhat but not proportionally to the cases. How is it that Johnson County has such a huge spike in cases but only 2.1 hospitalized per day for the whole county as of November 17? ​

The Regional Dashboard including Kansas and Missouri show hospitalizations going up to 138 per day, tracking a bit more closely with COVID-19 cases. Even with the spike in cases, hospitalizations went up by about thirty per day - in a metro area of about two million people.

One physician told me that it's likely KC hospitals are getting all of the sick people from outlying areas who would normally be treated in community hospitals or clinics for respiratory disease - but we have the specialized COVID-19 resources in the city.

​Johnson County Hospitalization Trends

​Mid America Regional Dashboard - KC and Greater KC Metro Areas

​Good news - given the spike in cases, we’ll know by Thanksgiving whether what the real implications are​ - because many are starting to question how these case counts are being used. It's crucial that a "positive" or case reflect an individual who has a clinical diagnosis as part of a healthcare encounter rather than just a diagnostic test with no clinician applying judgment. 

​3 - How many people are getting critically ill? (Needing ICU care?)

The public has been educated that SARS-2/COVID-19 poses a unique health threat that merits locking down economies, unemployment - stopping most of civil society.

How bad is it, really? As of November ​17, a greater percentage (​31%) of our regional ICU resources are being used for COVID patients according to public sources than previously - which is concerning, but shouldn’t be described using loaded terms such as “flooded” or “overwhelmed." We still have capacity, and additional overflow or "surge" capacity.

​4 - WHO is getting really sick, and who is dying? ​

The Johnson County data maps pretty closely to what the CDC showed in terms of ages and underlying conditions. COVID-19 kills older people in 70’s-80’s who have ​other health complications. Like influenza, there are a few outlier-type cases in which a younger, seemingly otherwise healthy person died.  Very few of the individuals who passed away would have been in the labor force, and ​66% of ​the deaths in Johnson Country were at Long-Term Care Facilities - which have been hit hard throughout the world.

​Is COVID-19 a unique challenge or is it highlighting the poor overall health of our population - given our access to improved nutrition, education about healthy lifestyles, and access to healthcare? ​Analysts are being shamed and called heartless for pointing out that people dying of COVID-19 were dying anyway, but kind of analysis is done all the time in healthcare and in the insurance industry. People are going to die of something, and trade-offs have to be made.

It is difficult to tell from our local data and the data from anywhere else in the world that there is a higher net loss of life including COVID-19 deaths than from other months or years. The deaths are not clearly additive or "in addition to" the number of people who would d​ie of pneumonia or other causes. I'm not stating there isn't a problem, but a pandemic should produce numbers that are clearly additive, if not exponential given our response. 

​Note the prevalence of pre-existing conditions for deaths by COVID-19. Many renal care patients are literally barely alive from week to week with congestive heart failure, diabetes, and are on dialysis. Pointing out that many who are being categorized as "death by COVID-19" were dying anyway has led to criticism and shaming, but the disease does not seem to kill young, healthy people.

​5 - Are our hospitals and ICU’s in danger of being “overwhelmed?” (And how ​Do we know besides hearing it on the news?)

Take a look at the charts. ICU census is usually high by design - because these are expensive beds at the hospital​. This also doesn't take into account ICU surge capacity, which can be brought online if needed. Prior to serious conversations about lockdowns and restrictions, public health officials and the media should show how the current census is an outlier. Where is the true breaking point  - and what would the real implication would be to healthcare services? Additional capacity could be provided by reducing optional procedures rather than implementing martial law...