Kansas began requiring masks, then virus cases dropped. Weeks later, ‘the data is solid’

The chart from Kansas health officer Lee Norman was eye-catching.

An orange line traced a steep fall in new cases among counties that followed Gov. Laura Kelly’s July 3 statewide mask order. A flatter blue line plotted new cases in counties that rejected the mandate, revealing little progress in slowing the spread of the virus.

The chart, which Norman showcased at an Aug. 5 news conference, was quickly criticized as “misinformation” because the lines for mask and non-mask counties followed separate vertical axes. It made the differences between them appear more dramatic.

But despite the confusion, an analysis of Kansas COVID-19 cases by The Kansas City Star and The Wichita Eagle broadly confirms Norman’s data. It shows an overall downward trend since last month in 16 counties with a mask order early on while 89 counties without one trended up.

Kansas also witnessed its first extended reduction in daily new cases since early June following implementation of Kelly’s order on July 3, according to the analysis. Meanwhile, Missouri doesn’t have a statewide mask order, making a similar analysis for that state more difficult.

In Kansas, the Democratic governor’s decision to mandate masks across the largely conservative state sparked a backlash that continues in some areas today. Under a state law Kelly signed in June limiting her pandemic authority, county commissions hold the power to opt out — and most did.

The resulting patchwork of local rules kicked off an experiment to learn whether ordering the use of masks is an effective policy. Some counties followed a rapidly expanding body of evidence that masks cut transmission of the virus. Others, effectively a control group, blazed a different path, emphasizing individual rights and freedoms.

To determine how Kelly’s order impacted the march of COVID-19 across Kansas, The Star and The Eagle analyzed case data collected by The New York Times from state and local health agencies. More than a month into the mask mandate, here’s what’s clear:

• Kansas’ 7-day rolling average of new cases peaked at 486 on July 17 and fell to 383 on Aug. 1 — a drop of more than 100.
  
  
• Mask counties on average reported fewer new cases per-capita in early August than in mid-July, while non-mask counties reported more.
• Kansas’ rolling average remains well above its previous April peak of 320 new cases a day, suggesting the mask order may have reached the limit of its effectiveness in pushing down case counts.

Since the statewide decline in new cases following the mask order, however, the fall has since stalled. In the week leading up to Aug. 9 — the last day of data The Star and The Eagle analyzed — the rolling average began creeping upward again. The rate of increase is much slower than before the mask order but is chipping away at some of the progress over the past month.

Neither KDHE nor Kelly’s office directly answered a question about the increasing average.

Steve Stites, chief medical officer at the University of Kansas Health System, said the effect of the mask order so far has been remarkable, and that over time it will continue to slow the spread of the virus.

“It’s going to take another month to really measure that effect because you have to get through second and third order spread,” Stites said during a virtual news conference Tuesday. “In order for the masks to fully take effect, it will require time.”

Kelly said masks are one of the best tools to slow the spread of the virus. She invoked comments by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who in an interview with ABC News this week recommended “universal wearing of masks” to combat the virus.

“This is not about politics,” Kelly said, adding that Democratic and Republican governors in 34 states have now mandated masks.

“Every action I have taken in response to COVID-19 has been informed by public health guidance, and to keep Kansans safe and keep our businesses open,” Kelly said in a statement. “That’s what I will continue to do until we have a vaccine.”

Health secretary: ‘The data is solid’

Although Kansas’ COVID-19 data shows counties with mask orders are recording fewer new cases, Norman initially stumbled in his effort to present it.

The secretary of the Kansas Department of Health and Environment’s now-infamous chart showed a decline since July 12 in the rolling average of daily cases in mask counties. The graph also showed the rolling average in non-mask counties but used a different vertical axis.

The result was that the lines plotting the decline in mask and non-mask counties intersected when they would not have in a standard graph — making the order’s impact appear more dramatic.

Norman was roundly criticized by Republicans. House Majority Leader Dan Hawkins said Norman distributed “misinformation.”

“The chart was incredibly misleading,” Hawkins said Monday.

Norman has since acknowledged the graph was “misunderstood” and said in retrospect, he would redraw it. But he vehemently defended the data behind it.

“The data is solid,” he said.

KDHE last week posted the data behind the chart, which it drew from the Centers for Disease Control and Prevention. While The Star and Eagle analysis relied upon data collected by The New York Times, both revealed the same overall trend.

Following Independence Day weekend, a 7-day rolling average measuring how fast county populations are being infected rose in both mask and non-mask counties, according to the newspapers’ analysis. The average peaked for all counties on or about July 17.

But over the next few days, mask and non-mask counties diverged. Counties with requirements experienced a steadily declining rolling average. Counties without plateaued for about 10 days before starting to climb again.

The analysis followed 16 counties, the same examined by KDHE. For the purposes of the analysis, Sedgwick County was counted as having a mask mandate. While the county rejected a mask order at first, Wichita, which dominates the county’s population, quickly issued its own rules.

A statewide rolling average of cases also fell beginning in mid-July, likely because many of the counties with mask orders have large populations — giving them greater influence over statewide trends. The rolling average calculated by The Star and The Eagle matched a rolling average calculated separately by The Times.

Those findings come as no surprise to Dr. Peter Chin-Hong, professor of medicine and infectious disease specialist at the University of California, San Francisco.

“It makes sense. It’s kind of compelling,” he said of the Kansas data. “It could be its own study to tell you the truth.”

He said several studies have shown mask mandates have helped slow the spread of both COVID-19 and previous strains of influenza. Research also shows that the benefits from mask orders only increases over time.

“It kinds of gets better and better the longer people do it,” he said.

Masks help the most with uncontrolled, indoor environments like grocery stores, he said. But too often people oversimplify the issue. Masks are just one tool, he said, along with social distancing and limits on mass gatherings.

State law prohibits Kelly from limiting mass gatherings until at least Sept. 15. The restriction was part of a compromise reached with Republican leaders on use of her emergency powers.

“Masks are not like a miracle,” Chin-Hong said. “They have to go with everything else. People like to make it a dichotomy. But it’s part of a strategy.”

Kansas counties credit masks

Across Kansas, local officials credit the mask mandate with providing at least some help.

In Johnson County, the state’s most populous, daily new cases have leveled off and even begun declining. Over the past week, the county reported 629 new cases, an average of 90 a day, according to Sanmi Areola, the county public health director. As recently as July 12, the county was averaging 116 a day.

“Masks work,” Areola said. “The trajectory of the positivity rate changed (and) leveled off during the same time period. This indicates that the spread of the virus is not getting worse and may in fact be improving.”

In the central Kansas county of Reno, which initially opted out of Kelly’s order before reinstating it on July 14, the percentage of positive tests for COVID-19 appears to be trending downward, health officer Nick Baldetti said.

Reno County Commission Chairman Ron Sellers said members of the body changed direction based on the views of Baldetti. They also worried that rising cases in nearby Sedgwick County would also lead to a spike in Reno.

Since the order went into effect, more people are wearing masks in public, he said.

“It didn’t make it 100%,” Sellers said. “But it raised it. Because I think there are sincere people that whether they agree or disagree will follow what the law is.”

He said the order appears to have helped slow the spread of the virus, though he noted the county was fighting against a spike in cases following July 4.

“I believe in masks so I would suggest to you that it is making a difference,” he said. “I hope we can get away from the masks soon. I’m not a scientist, but I believe if everybody in Reno County would wear masks for the next six weeks, we probably wouldn’t have an issue six weeks from now. But that’s not going to happen.”

In Douglas County, home of Lawrence, the 7-day average of new cases dropped precipitously following the county’s July 1 mask mandate. Likewise, the rate of tests coming back positive dropped from 10.1% in late June to 5.2% in early August.

The mask order came just two days ahead of another major preventive effort: the mandatory closure of all bars and nightclubs.

“We did those within days of each other,” said George Diepenbrock, spokesman for the Lawrence-Douglas County Health Department. “Our sense is that they both have had a good effect on our case numbers”.

In Mitchell County, in north-central Kansas, cases have been trending down since a July 17 peak of 18 active cases. On Tuesday, county health administrator Cortney Murrow said the county only had one.

But the county of 6,200 has had fewer than 30 cumulative cases. It never opted out of the governor’s order, but Murrow wasn’t sure that masking alone has kept numbers low. She said residents were largely taking masking, hygiene and social distancing recommendations seriously.

“I don’t think it’s one factor,” Murrow said. “Our community has done a really good job of seeing the severity of it. They’ve done a really good job with personal accountability and knowing what it takes to prevent the spread.”

Mask compliance still a problem

More than a month after Kelly issued her statewide mask order, compliance remains uneven.

Bourbon County Emergency Manager William Wallis estimated 50 percent to 60 percent of residents are covering their faces in public, a meaningful increase in the southeast Kansas community.

He said the issue remains divisive, but that continued education by local officials has helped convince more people to mask up. Still, with limited enforcement, he said it’s tough to expect full compliance.

“Unless there’s some teeth to it so that they can go around and arrest people, you’re going to have the rogues,” Wallis said.

Fort Scott, the Bourbon County seat, lost its only hospital in 2018 — placing it among the 11 Kansas counties without one.

Wallis believes more mask use is helping to keep cases down to a total of 71. He said most of the county’s cases have been related to travel as residents, particularly younger ones, grew antsy from staying put.

“People were getting the itch to go on vacation. And they did,” he said. “And when they came back they brought a case or two with them.”

Kansas City, Kan., Mayor David Alvey said the mask order has helped Wyandotte County make progress in slowing the spread of the virus. The county implemented its own order a few days before Kelly’s statewide mandate began.

Wyandotte County’s rolling average for cases is now about 43 cases a day, he said, roughly the same level as in mid-April.

Still, not everyone is putting on a face covering.

“I think what we’re seeing is there’s some who are still not complying and we’re still seeing some people continue to gather in large groups where the transmission risk is much higher,” Alvey said during a virtual news conference hosted by the University of Kansas Health System.

Masks have become markers of cultural or political identity in some situations. During legislative hearings in Topeka, Democrats often wear masks while Republicans don’t. This summer, GOP Senate candidates Roger Marshall and Kris Kobach regularly appeared at public events without a mask.

Exhortations from public health leaders early in the pandemic to avoid wearing masks and instead save them for medical workers and first responders helped sow the seeds of doubt when experts subsequently urged widespread mask use.

And individuals who say they have health conditions that prevent them from wearing a mask say they are subjected to harassment. Marty Spence, who owns Songbird Juice Co. in Wichita, said she has a condition that stops her from wearing a face covering.

“But I’ve been labeled an anti-masker, I’ve been called ruthless names in the arena,” Spence told the Sedgwick County Commission.

Commissioner Jim Howell said shaming people for not wearing a mask, especially when the reason might not be clear, is “a real problem.”

But Stites, the chief medical officer at the University of Kansas Health System, said there’s “absolutely no question” about the importance of mask wearing.

“And anyone who thinks it’s not important is deluding themselves because they just don’t want to wear it or think it’s become a political statement or any of that other bunch of bologna,” he said.

The Star’s Sarah Ritter contributed reporting

This story was originally published August 16, 2020 at 5:00 AM.