Kansas records third death and surpasses 126 positive tests for coronavirus; Gov. Kelly signs bill with $65 million in virus response funding; hospitals anticipate onslaught of sick people within weeks; doctors prepare for difficult ethical choices; physicians urge experimental use of medicines

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TOPEKA — Kansas Army National Guard Col. Lee Norman said the military prepares for war in times of peace.


And, to a degree, so do civilian hospitals.


Norman, who also leads the Kansas Department of Health and Environment, said crisis standards for care would guide medical decisions as the new coronavirus infection surged in Kansas. This playbook of sorts will assist physicians whenever demand spikes for intensive-care beds, ventilators and medicines, even drugs not yet clinically proven effective against COVID-19.


What should a Kansas doctor do with two seriously ill patients and access to one ventilator?


"We know, for example, that an 80-plus-year-old that gets on a ventilator with coronavirus is very unlikely to survive," Norman said. "Does that mean we abandon that patient? Heavens, no. We try to do the best we can with the most people. We’ve not gotten into that bad situation, yet. I’m optimistic we won’t."


On Wednesday, Kansas health officials said the state had at least 130 confirmed cases of COVID-19, up from 98 on Tuesday. KDHE estimates Kansas infections could double every three or four days and reach about 400 by April 1, which would put greater strain on personnel, equipment and supplies at hospitals in Kansas. The totals won’t decrease "anytime soon," the KDHE secretary said.


Health facilities in urban centers — more than half Kansas’ known infections are in Wyandotte and Johnson counties — would become magnets for the sick.


"We think we’re two to three weeks away from really accelerating," said Steven Stites, chief medical officer of the University of Kansas Health System in Kansas City, Kan.


Norman said Kansas officials were making an argument to the Federal Emergency Management Agency that sparsely populated states should receive medical gear and equipment needed to counter the virus in amounts proportional to the population base. For example, he said, the 4.5% positive-test result in Kansas with 2.9 million residents was similar to the percentage in California, which has 39.5 million people.


Meanwhile, Gov. Laura Kelly signed a state budget bill allocating $65 million to support the coronavirus response in Kansas.


Follow instructions


Norman said part of the problem in Kansas appeared to be a willingness of people to circumvent calls and orders by health officials to stay at home, avoid social interaction and adhere to sanitation advice. He urged people to take home isolation seriously.


"Unfortunately, people are looking at this stay-at-home order as, ’OK, what are the exceptions and how can I wiggle around them?’ " Norman said. "That is exactly the wrong approach."


He said it was "unlikely" incidence of the coronavirus in Kansas would drop off to a point that people could safely fill church pews in April on Easter Sunday as suggested by President Donald Trump.


KDHE has 125 pages of requests from counties and health care organizations for medical supplies, Norman said, and the agency is unable to meet all requests. However, the state received two truckloads of supplies earlier this week from FEMA. Additionally, KDHE is working with various care providers to obtain ultraviolet light and other sterilization devices so medical personnel can reuse masks five or six times.


Testing remains restricted, Norman said, because materials are in short supply, sometimes down to "just the gnat’s eyebrow" before new supplies arrive.


On Tuesday evening, Wyandotte County/Kansas City, Kan., health officials reported the county’s second death related to COVID-19. The third fatality in Kansas was identified as a man in his 70s. He tested positive March 18, was discharged from a hospital Friday and entered the hospital again Sunday. He died Monday.


"We offer our prayers and thoughts to the family and friends of the deceased. Their sadness is our sadness. Our own family and friends are precious to us, and so I call on each one of us to protect one another and stop the spread of COVID-19," said David Alvey, mayor of the unified government of Wyandotte County and Kansas City, Kan.



Fiscal restraints


Kelly on Wednesday signed a state budget passed by the Legislature last week that includes $65 million in funding for dealing with the coronavirus.


Kelly warned against adding unnecessary spending when the state returns at the end of April. Already, the budget is $100 million more than the one she proposed at the start of January. A compromise package agreed upon by House and Senate negotiators before the Legislature adjourned calls for an additional $100 million in obligations from the state general fund to be added after lawmakers return at the end of April.


"Practically overnight, the coronavirus pandemic caused upheaval in the stock market, shuttered businesses, disrupted supply chains, and cast uncertainty on our economic future," Kelly said. "We’ve never experienced anything this sudden and severe in our lifetimes. As we get a handle on our new reality, I urge the Legislature to join me in showing fiscal restraint when they return for the annual wrap up session. It is critical that we act with utmost caution until we get a better sense of what the true budget implications of coronavirus will be."


The governor chose not to veto any line items in the budget.


Senate President Susan Wagle, a Republican from Wichita, praised the governor for taking swift action to unlock aid appropriated to combat COVID-19.


"Our working families, small businesses, healthcare providers and hospitals are facing unprecedented hardship," Wagle said. "Remember our state motto, ad astra per aspera, means ‘to the stars through difficulty.’ United, we will conquer adversity."


Meanwhile, the Kansas Department of Transportation announced it was extending the deadline for local communities to submit applications for a cost share program to receive state assistance on local infrastructure projects. The new deadline is May 18.


"Given the impacts of COVID-19 on communities across Kansas, we want to give our partners more time to develop and submit their cost share applications," said KDOT Secretary Julie Lorenz. "Getting infrastructure investments into the Kansas economy and putting people back to work will be a top priority of COVID-19 recovery."


Plaquenil in spotlight


Surgeon and former Kansas Gov. Jeff Colyer and physician Daniel Hinthorn, director of infectious disease at the University of Kansas Medical Center, made the case in a Wall Street Journal opinion piece for treating coronovirus with the antimalarial drug hydroxychloroquine, also known as Plaquenil, and the upper-respiratory infection drug azithromycin, with the brand name Zithromax Z-Pak.


The combination showed promise in a small number of patients in France that were reportedly cured with a six-day treatment, the Kansas doctors said.


"One lesson that should inform the U.S. approach: Use this treatment cocktail early, and don't wait until a patient is on a ventilator in the intensive-care unit," Colyer and Hinthorn said.


They said hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment of patients testing positive or presumed to be infected. The federal government should contract with manufacturers to ramp up production because the drug is in short supply, they said.


Both were pleased that Trump touted hydroxychloroquine as a potential treatment.


"We don't want to peddle false hope," they said. "We have seen promising drugs turn out to be duds. But the public expects an answer, and we don't have the luxury of time. We can use this treatment to help save lives and prevent others from becoming infected."


Dana Hawkinson, director of inpatient critical care at the KU hospital and an infectious diseases specialist, said there was anecdotal evidence in the Kansas City area of rapid growth in demand for Plaquenil.


He said coronavirus patients at KU were receiving the drug in a "very regimented manner," but expressed concern about potential shortages.


"I need to stress. These are not benign drugs," Hawkinson said. "There are still people who are really sick with conditions for which they are approved and need these drugs."