On Friday, Kansas City, Missouri, takes big steps toward reopening after weeks of stay-at-home orders to stop COVID-19 from spreading.
Advocates for reopening point to a desperate need to get the economy back on track and to some encouraging data about the virus, while health experts say strong warning signs show Kansas City is still in a precarious spot.
Here’s what experts and data tell us about Kansas City's progress in overcoming the virus:
1. COVID-19 numbers in Kansas City have generally been much lower than in many other parts of the U.S.
For weeks in March and April, when New York City, Boston and other cities were reporting hundreds or thousands of new COVID-19 cases every day, Kansas City’s daily count rarely exceeded two dozen.
Analyses conducted by the City Observatory think tank in mid-April and by McClatchy newspapers in early May found that the Kansas City metro area ranked near the bottom of metro areas nationwide in COVID-19 infection rates.
Experts say low testing rates probably made Kansas City’s infection rates look lower than they actually were, although many others cities have also struggled with low testing rates.
2. The outlook in Kansas City has been changing quickly.
The numbers of new cases began to rise sharply starting in late April. Hundreds of mostly asymptomatic cases were diagnosed in the last three weeks, many of them found during surveillance testing at places like meat packing plants and nursing homes.
These cases would have been missed early in the pandemic, when testing was almost entirely reserved for people who had symptoms.
But Kansas City, Missouri, health department director Dr. Rex Archer says the data also reflects an increase in local spreading in other parts of the area as well.
“I think it’s both,” Archer says. “I think we are still increasing, and we are becoming more aware of them because we are doing a little bit more testing.”
3. Social distancing has been working.
Ron Fricker, an infectious disease researcher at Virginia Tech, thinks it’s obvious that social distancing has had an enormous effect.
“We have very clear evidence social distancing works, because we proved it by flattening the curve, at least nationally,” Fricker says. “We’ve done a really good job of flattening the curve. We have not done a very good job, broadly speaking, of bringing the curve down.”
Without any social distancing or other preventive measures, people with COVID-19 typically transmit the virus to 2 or 3 other people. This possibility for exponential growth led to many of the worst-case projections that the disease would overwhelm hospitals.
Instead, Kansas City and many other communities have seen a slower and more moderate spread.
The Big Cities Health Coalition and Drexel University estimate that social distancing in Kansas City saved 1,922 lives and prevented 17,723 hospitalizations.
4. Experts are worried about loosening social distancing early.
While Kansas City has avoided exponential spread of COVID-19, it has not managed to achieve a downtrend trend in cases that many guidelines suggest.
Speaking at a virtual press event in late April, Dr. Steven Stites, chief medical officer of the University of Kansas Health System, acknowledged that reopening was taking shape before many important tools where available.
“From a public health perspective, when is the right time? The answer is when you have vaccinations and therapies, or at the very least you have really adequate ability to test for who’s got it, contact tracing, and that you can measure who’s been infected — that is the antibody testing,” Stites said.
One of the most optimistic COVID-19 models, created by researchers at the University of Washington, projected that the virus peaked in April.
However, the model was based on the assumption that communities would maintain stay-at-home measures for a longer period.
The revised model now shows COVID-19 infections will peak in Missouri on May 20.
5. Many Kansas City residents have been loosening up on social distancing for weeks.
Social distancing in Jackson County, Missouri, appears to have peaked on April 11, according to Unacast, a company that analyzes cell phone data. Residents reduced nonessential traveled by 70%, but travel has gradually crept back up closer to normal levels.
6. Hospitals in Kansas and Missouri have been spared from the overwhelming surge of patients some early models projected.
Hospitals in Kansas and Missouri have seen far fewer patients than had been feared in the early days of the pandemic. Worries about hospitals exceeding their capacity of beds and ventilators prompted many city and state stay-at-home orders.
Data from state hospital associations and hospitals themselves show that the numbers of COVID-19 patients in hospitals has generally been declining for weeks
“In no part of the state — including in hard-hit St. Louis — are we near capacity,” wrote Missouri Hospital Association spokesperson Dave Dillon in an email.
Many hospitals have slowly resumed doing non-urgent procedures, so the use of beds and equipment has been increasing, but a report from this week showed there are still more than 2,000 hospitals beds, 400 ICU beds and 1,927 ventilators available for use in Missouri.
7. Testing has increased significantly, at least in some areas, though it still may not be enough.
The World Health Organization recommends that communities test enough people so that 10% or less of those tests are positive. Experts believe that positive cases should be a small percentage of the total number tested to ensure the sample size is large and diverse enough to accurately represent the wider population.
Currently, about 8% of tests in Missouri are positive, and 7% of tests in eastern Jackson County are positive.
By other measures, testing rates are still too low. Missouri Gov. Mike Parson said in April that Missouri needed to test between 50,000 and 60,000 people per week to have a solid understanding of the spread of the virus. Since then, he has said Missouri has reached its capacity to conduct that many tests, but testing rates are still far below those levels.
Archer, the Kansas City health department director, says 750 Kansas City residents should be tested per day, which is also well above current testing levels.
Archer says the health department’s ability to address the virus is limited because the department has not yet received any federal emergency funds.
8. Many people should continue to stay home.
Federal, state and local governments have all crafted their own reopening plans and metrics, and some contradict others. But the plans generally agree on at least one important point: People who are at higher risk for developing severe illness should continue to stay home and practice social distancing through the first phases of reopening.
This includes roughly a third of the population, according to a study from the Kaiser Family Foundation, which shows that a large segment of Americans are considered at-risk for severe illness due to age, compromised immune systems or other conditions.
Archer, who also suggests that people who live with at-risk individuals should also avoid going out, says the number of new cases in the coming weeks will hinge on whether people continue to practice social distancing, despite the opening of businesses.
“Whether it’s a lot or not will depend on whether most people ignore the fact that we’re reopening and stay at home or stay careful and prudent in what they are doing,” Archer says.
9. More waves of COVID-19 are expected, sooner or later.
As business and restaurants reopen, the risk for infections will increase, and health experts widely believe that will lead to more infections and surges in cases.
These could result in a much larger wave than the current one and potentially create a heavier toll on the economy, according to Georgetown University infectious disease researcher Claire Standley.
“If we focus too much on trying to get the economy back on its feet and ignore some of the public health advice and evidence that’s out there, we could risk having an actually worse economic impact down the road if there is a significant second wave, for example, or if we end up resulting in a higher burden of disease and death tolls than even current models predict,” Standley says.
The example of other states suggests that such a surge may not happen suddenly. Georgia and Florida, two states that reopened early despite high rates of the virus, have not seen spikes in infection, though experts say it may still be too early for these to appear in data.
10. The COVID-19 pandemic will probably not end with a satisfying conclusion any time soon.
In mid-March, when many stay-at-home orders had first gone into effect, Washington University infectious disease expert Steven Lawrence predicted the debate that has caught fire in the past few weeks about the need for social distancing mandates.
If areas that implemented social distancing orders were not overwhelmed by cases, he said, many residents would likely question the actions.
“If we are successful with all of these measures, we will be in a situation where it looks like we overdid it,” Lawrence said. “In other words, success would potentially lead to frustration.”
However, Lawrence said, the alternative path of less restrictions with more infections and potential deaths would be even more painful.
Regardless of the outcomes in the COVID-19 pandemic, Lawrence said second guessing and doubts about strategy were inevitable.
“This is one of the difficult aspects of managing an outbreak like this,” Lawrence said.
