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Technology, science, and math

Corbevax gets its approval

Kudos.

The Peoples Vaccine
Image courtesy of Texas Children’s Hospital

Texas Children’s Hospital and Baylor College of Medicine today announced Corbevax — a protein sub-unit COVID-19 vaccine — has received approval from the Drugs Controller General of India to launch in that nation.

The vaccine has been developed in Houston by Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Center for Vaccine Development at Texas Children’s Hospital and Dr. Maria Elena Bottazzi.

Hotez called the approval “an important first step in vaccinating the world and halting the pandemic.”

[…]

Bottazzi and Hotez led efforts at Texas Children’s Hospital to develop the “initial construct and production process of the vaccine antigen.” After the vaccine was found to be “safe, well tolerated and immunogenic,” the Drugs Controller General of India granted emergency use authorization.

Corbevax completed two Phase III clinical trials with more than 3,000 subjects. The trials suggested a better immune response to the Ancestral-Wuhan strain of the virus as well as the delta variant compared to Covishield, which was developed by Oxford-AstraZeneca. None of the subjects showed severe adverse reactions to the vaccine; and adverse effects in the study were half of those from Covishield.

See here for the background. Vaccine supply isn’t a problem in the US and Europe but it is a problem in many parts of the world. We know very well that the more opportunities this virus gets to spread and mutate, the more chances it has to turn into something worse and more dangerous. Hopefully Corbevax can help close that gap. Kudos to all involved. Here’s the Texas Children’s Hospital page about Corbevax and its development, and CultureMap has more.

Climate change and freezing weather

A little science for you.

It was the coldest February Texas had seen in more than four decades, and the sustained blast of arctic air knocked out much of the state’s power grid for several days, causing hundreds of deaths and billions of dollars in damage.

Yet 2021 also brought the planet’s 16th-warmest February since records began. On average, winters are getting more mild because climate change has increased temperatures worldwide. How could a warmer world bring such a severe cold snap to Texas?

Scientists say they are still working to understand the relationship between climate change and extreme winter weather patterns. Many factors can influence localized cold snaps, and evidence suggests that climate change is affecting longstanding climate patterns in new ways.

“The way those kinds of events occur involve a lot more complicated atmospheric processes,” said Jennifer Francis, a senior scientist and acting deputy director for Woodwell Climate Research Center in Falmouth, Massachusetts.

Francis and other scientists said there’s a significant body of research that can help explain why Texas — and other areas of the U.S. — may still experience extreme cold from time to time amid an overall warming of the planet.

“Maybe there was some nuance that was missed when people started talking about winters disappearing and how we’re never going to see snow again,” said Judah Cohen, a leading scholar on winter weather and climate change and the director of seasonal forecasting at the climate analytics company Atmospheric and Environmental Research. “People say, ‘I was told one thing and I’m experiencing something else.’”

Several factors impact the frequency and severity of cold spells in Texas, from the strength of the polar vortex — a seasonal, swirling mass of cold air that circles high above the Arctic — to whether we’re in an El Niño or a La Niña year, which influences whether Texas has a wet or dry winter, to the natural patterns that influence the position and strength of the jet stream, which can determine the path and duration of weather systems.

Here’s what factors scientists say can cause an extreme cold snap to hit Texas — and how such storms may be influenced by climate change.

You should read the rest, because it’s pretty interesting. The science is still being developed, and so there’s disagreement about some of the findings, but the big picture is there. You might familiarize yourself with the concept of a “polar vortex”, because it’s a key factor. Hope for the best and be prepared, whatever happens.

A broader look at the Houston project to track COVID in wastewater

The DMN tells me things I did not know about my current favorite public works project.

The [Houston] health department is conducting the wastewater surveillance for COVID-19 in partnership with researchers at Rice University and Baylor College of Medicine. Wastewater testing cannot identify individual people who have COVID-19, but it can identify neighborhoods with particular virus variants or relatively high virus loads.

Dallas County is not participating in similar wastewater surveillance to track the virus, said Dr. Philip Huang, director of Dallas County Health and Human Services. He said he doesn’t know of any other organizations or municipalities in North Texas that are operating similar programs.

While Dallas County previously considered using wastewater surveillance, the price of creating such a system was too high. “It’s actually quite expensive to set that up,” Huang said.

“After the 10-week survey, [the water district] discontinued its participation in the study due to inconsistent data that required continuous interpretation by local and state public health officials,” said Kathleen Vaught, public relations specialist at the water district.

Public health experts have long used wastewater samples to track the growth and spread of bacteria and viruses, like the poliovirus.

The Centers for Disease Control and Prevention began discussing the use of the tool to study COVID-19 in February 2020.

By September of that same year, the CDC and the U.S. Department of Health and Human Services launched the National Wastewater Surveillance System, also known as NWSS, to help state, tribal and local health departments track and respond to COVID-19.

[…]

Houston is the only Texas city to participate in the NWSS, although that could change as the program grows in the next month, said NWSS team lead and CDC microbiologist Dr. Amy Kirby. Data taken from Houston wastewater samples is submitted to a national database tracking similar data from nearly 400 utilities across the country.

The University of California, Merced’s Naughton Lab created and maintains a dashboard, called COVIDPoops19, to track global wastewater testing for the virus.

I just want to say that learning of the existence of a dashboard called COVIDPoops19 has improved my life in ways I could not have imagined. You can zoom in on Houston in this dashboard and click on the various icons to learn more; clicking on the icon for Baylor College of Medicine led me to the actual Houston dashboard for this, which I had not seen before. If you play around with the slider, which shows you what the viral levels were for past weeks, you can see that the inflection point for this year was the week of June 21 – levels had been dropping through June 7, then you saw a few upticks on June 14, and on the 21st it was all increases, and it got worse for the next few weeks. We’re on more of an upward trend right now (December 6 is the most recent date), but there are increases and decreases in the various locations. I’m going to be bookmarking this page. Anyway, if you want to know more about this project, there you go.

Corbevax

Very cool.

A Houston-made COVID-19 vaccine will likely be approved for use in India by the end of the year, said Dr. Peter Hotez, co-director of Texas Children’s Hospitals Center for Vaccine Development.

Hotez and his co-director, Dr. Maria Elena Bottazzi, created the vaccine as a cheap and easy-to-produce option to fill global gaps in vaccine coverage. Dubbed Corbevax, it uses a safe and traditional vaccine technology, called recombinant protein subunit, that has been used for decades in the hepatitis B vaccine and is therefore easier for other countries to make themselves.

Drug maker Biological E has agreed to manufacture 300 million doses in India, where 36 percent of the population is fully vaccinated and 59 percent have at least one dose. Efficacy data has been submitted to the Drugs Controller General of India for authorization.

The vaccine does not have a patent, and Hotez hopes manufacturers in other low- or middle-income countries will take advantage of its availability.

“If you leave large populations unvaccinated, that’s where the greatest concerns of variants arise,” he said, referring to the current spread of the omicron variant from the largely unvaccinated South African population. “So this vaccine is therefore needed not only for global health but also economic development.”

Bottazzi, who is from Honduras, is especially interested in the vaccine’s proliferation throughout Latin America. Less than 40 percent of the population is fully vaccinated in several countries there, according to the New York Times global virus tracker.

“Corbevax is gong to be a trailblazer,” she said.

The work is based on research they had done for a SARS virus but never took to a human trial because the virus had receded by then. Anything we can do to get more shots in arms is absolutely a good thing. Kudos to all for the achievement.

Omicron may be coming, but delta is still here

It’s still a big problem, in case we haven’t forgotten.

Omicron’s arrival in the U.S. came as no surprise to federal health officials and will be met with similar anticipation in Texas, where experts believe it could show up in state and local sequencing efforts as soon as this week.

“It’s almost certainly here,” said Dr. Benjamin Neuman, a Texas A&M University professor and chief virologist at its Global Health Research Complex, which does sequencing for COVID-19 variants.

On Monday, federal health officials concerned about omicron urged eligible vaccinated adults to get their booster shots to increase their protection from COVID-19, in whatever form it might take over the winter, and to keep masking, hand-washing and social distancing when possible.

In Texas, state health officials say they are ready to assist hospitals should another surge happen over the holidays and they are ramping up their own efforts to identify more variants in more parts of the state.

But their largest push, at least publicly, is for vaccination and booster shots. About 55% of Texans were fully vaccinated as of Dec. 1. Some 18.7% of fully vaccinated Texans have had boosters, according to state health numbers.

“Prevention is important, and vaccination remains our best prevention tool,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services.

[…]

Texas hospitals are still in the throes of a staffing shortage after almost two years of deadly surges and a summer wave of deaths and hospitalizations that saw record numbers of ICUs filled to capacity.

With more than 13 million Texans still not fully vaccinated, the fear of the medical community here is that another wave will further strain a health care system that is already exhausted and depleted.

At the moment, without more data about omicron, delta is still the variant likely to cause the most problems this winter, Neuman said.

“Today, it’s the delta wave that worries me. Not omicron yet,” Neuman said. “We’ve got to wait and see what omicron does, if anything. But with cases rising across the country — that’s entirely being driven by delta.”

There’s some interesting stuff in the article about how scientists in Texas are tracking different variants here – did you know there was such a thing as the Texas Variant Partnership? I didn’t – so read on. Everything I’ve read about omicron so far suggests it will be a couple of weeks before we have some real data on it, which will help us understand basic questions about how transmissible it is, how deadly it is, and so on. A huge question, especially in a still largely unvaccinated state like Texas is how much protection is natural immunity versus vaccination. I’m betting on the latter, but it’s certainly a possibility that another booster may need to be developed. Which, thanks to the nature of mRNA vaccines, can be done quickly, like three to four months. In the meantime, stay cautious and for crying out loud get your shots.

Deer COVID

In case you were running low on things to feel anxious about.

Scientists have evidence that SARS-CoV-2 spreads explosively in white-tailed deer and that the virus is widespread in this deer population across the United States.

Researchers say the findings are quite concerning and could have vast implications for the long-term course of the coronavirus pandemic.

Since SARS-CoV-2, the coronavirus that causes the disease COVID-19, first emerged, there have been several signs that white-tailed deer would be highly susceptible to the virus — and that many of these animals were catching it across the country.

In September of last year, computer models suggested SARS-CoV-2 could easily bind to and enter the deer’s cells. A recent survey of white-tailed deer in the Northeast and Midwest found that 40% of them had antibodies against SARS-CoV-2.

Now veterinarians at Pennsylvania State University have found active SARS-CoV-2 infections in at least 30% of deer tested across Iowa during 2020. Their study, published online last week, suggests that white-tailed deer could become what’s known as a reservoir for SARS-CoV-2. That is, the animals could carry the virus indefinitely and spread it back to humans periodically.

If that’s the case, it would essentially dash any hopes of eliminating or eradicating the virus in the U.S. — and therefore from the world — says veterinary virologist Suresh Kuchipudi at Penn State, who co-led the study.

[…]

From April to December of last year, about 30% of the deer that they tested were positive for SARS-CoV-2 by a PCR test. And then during the winter surge in Iowa, from Nov. 23, 2020, to Jan. 10 of this year, about 80% of the deer that they tested were infected. At the peak of the surge, Kapur says, the prevalence of the virus in deer was effectively about 50 to 100 times the prevalence in Iowa residents at the time.

During this time frame, the team also sequenced the genes of nearly 100 samples of the virus. They found the variants circulating in the deer matched the variants circulating in people.

Those genomic sequences suggest that during the pandemic, deer have caught the virus from people multiple times in Iowa alone, Kapur says. “The data are very consistent again with frequent spillover events from humans into deer and then transmission among the animals.”

Virologist Linda Saif at Ohio State University’s College of Veterinary Medicine says humans are likely infecting white-tailed deer across the country. The white-tailed deer is native to North America, Central America and the northern edge of South America. In the U.S. alone, there are an estimated 30 million animals.

“We also have detected the virus in deer in Ohio,” she says. “And there are antibody studies that suggest the prevalence of COVID infections among deer are pretty high in the Midwest and East.”

Although the virus doesn’t seem to make the animals sick, Saif says, the new data from Iowa are “very concerning.”

“Now the question is: Can the virus spill back from deer to humans? Or can deer transmit the virus effectively to grazing livestock? We don’t know the answers to those questions yet, but if they are true, they’re obviously concerning,” she says.

Yeah, I’d say so. Have I mentioned lately that getting vaccinated, and then getting boostered when you need to, is a really good idea? The odds are that sooner or later, we’ll all need a different version of the COVID vaccine, just because some awful new variant has arisen. This is the same reason why we need new flu shots every year. The sooner we accept that reality, the better off we’ll all be. USA Today and Texas Public Radio have more.

The Pfizer pill

This would be a big step forward.

Pfizer Inc. said [recently] that its experimental antiviral pill for COVID-19 cut rates of hospitalization and death by nearly 90% in high-risk adults, as the drugmaker joined the race for an easy-to-use medication to treat the coronavirus.

Currently most COVID-19 treatments require an IV or injection. Competitor Merck’s COVID-19 pill is already under review at the Food and Drug Administration after showing strong initial results, and on Thursday the United Kingdom became the first country to OK it.

Pfizer said it will ask the FDA and international regulators to authorize its pill as soon as possible, after independent experts recommended halting the company’s study based on the strength of its results. Once Pfizer applies, the FDA could make a decision within weeks or months.

Since the beginning of the pandemic last year, researchers worldwide have been racing to find a pill to treat COVID-19 that can be taken at home to ease symptoms, speed recovery and keep people out of the hospital.

Having pills to treat early COVID-19 “would be a very important advance,” said Dr. John Mellors, chief of infectious diseases at the University of Pittsburgh, who was not involved in the Pfizer study.

“If someone developed symptoms and tested positive we could call in a prescription to the local pharmacy as we do for many, many infectious diseases,” he said.

[…]

Study participants were unvaccinated, with mild-to-moderate COVID-19, and were considered high risk for hospitalization due to health problems like obesity, diabetes or heart disease. Treatment began within three to five days of initial symptoms, and lasted for five days. Patients who received the drug earlier showed slightly better results, underscoring the need for speedy testing and treatment.

Pfizer reported few details on side effects but said rates of problems were similar between the groups at about 20%.

It’s much better to prevent COVID than to treat it, in the same way that it’s much better to prevent malware from getting on your computer than to clean up after it. As such, getting vaccinated is still far and away the best thing to do to mitigate the risk of COVID. But if I want to extend the cybersecurity analogy, you must have multiple layers of defense to truly have good security practices, and so having a safe and reliable treatment to COVID that can keep people out of the hospital is crucial. I look forward to both the Pfizer and Merck pills getting approved by the FDA.

Don’t forget your flu shot

The flu is going to be back this year. Don’t fall for it.

After a historically light flu season in 2020, experts warn an influenza resurgence is looming this fall and winter.

“I would expect a more intense influenza season, simply because we did not have a flu season last year,” said Dr. Pedro Piedra, a virologist at Baylor College of Medicine.

Flu exposure breeds a level of natural immunity, creating a cellular memory of prior infections in those it infects. The absence of influenza last year, due to widespread masking and social distancing, has left many with a weakened immune defense — a development that could spell trouble as Texans venture out in droves this fall.

The return of the familiar body aching, fever-inducing wintertime scourge could not arrive at a worse time. Hospitals are still reeling from the fourth surge of COVID-19 spurred by the highly contagious delta variant and stagnating vaccination rates.

Experts predict flu season could hit Houston by early November.

“Now is the time to start making flu vaccine appointments,” Piedra said.

This past year was a historic anomaly due to COVID restrictions and precautions, and the lack of those plus a year out from anyone getting the flu we’re likely to see a resurgence. The flu shot may not be quite as effective this year, as it will be harder to model what it needs to be, but it will still be way better than nothing. Don’t miss out.

Your thermostat may be plotting against you

Welcome to 2021.

Amid [recent] sweltering temperatures in Houston, the agency that operates the state’s power grid asked residents to cut back on how much electricity they used to help it meet demand. That’s how some people apparently learned the hard way that their “smart thermostats” were programmed to rise in their homes when grid conditions got tight.

A user posting on the Reddit page for discussions about Houston wrote of knowing eight people with thermostats that bumped up automatically and made their homes less cool — sparking a conversation about how and why this happens. The concerns were first reported by KHOU.

Turns out, utility customers can opt in to programs that automatically adjust their thermostats when demand is high and grid capacity is strained. Those people can also opt out. Some, it seemed, were caught unawares.

One user wrote of being automatically enrolled in a program and then waiting months while trying to get out of it. Another reported sending an email to get removed from the service.

A third chastised them all: “This is what happens when you don’t read the contract.”

A software provider called EnergyHub works with thermostat manufacturers to run such programs. No one is enrolled without their consent, said Erika Diamond, the company’s vice president for customer solutions.

The idea is to reduce energy load when the grid is stressed, such as during an extreme weather event, Diamond said. Temperatures at George Bush Intercontinental Airport hit at least 95 degrees every day from June 11 through June 16.

I’m sure this was somewhere in your user agreement, which I know we all read thoroughly. One could easily argue that this is a net benefit for all, as the modest reduction in A/C that everyone affected by this would experience would save energy and maybe avoid some blackouts. It’s almost certainly more effective than asking people to voluntarily dial it back, as some won’t do it and others won’t be aware you’re asking. But it would be better if people were generally aware of this, even if it meant more of them opted out or manually overrode the auto-adjustment as they can do, if only to prevent the inevitable conspiracy theories and overall mistrust that a lack of awareness will spawn. At least it’s mostly been not-so-hot since then, so this has been less of an issue, but obviously we can’t just count on that. Reform Austin and Mother Jones have more.

Is it a car that flies or a plane that drives?

It’s a little of both.

Photo from Klein Vision

A prototype flying car has completed a 35-minute flight between international airports in Nitra and Bratislava, Slovakia.

The hybrid car-aircraft, AirCar, is equipped with a BMW engine and runs on regular petrol-pump fuel.

Its creator, Prof Stefan Klein, said it could fly about 1,000km (600 miles), at a height of 8,200ft (2,500m), and had clocked up 40 hours in the air so far.

It takes two minutes and 15 seconds to transform from car into aircraft.

The narrow wings fold down along the sides of the car.

Prof Klein drove it straight off the runway and into town upon arrival, watched by invited reporters.

He described the experience, early on Monday morning, as “normal” and “very pleasant”.

In the air, the vehicle reached a cruising speed of 170km/h.

It can carry two people, with a combined weight limit of 200kg (31 stone).

But unlike drone-taxi prototypes, it cannot take off and land vertically and requires a runway.

I’ve blogged about flying cars a few times before – what can I say, the subject is fascinating, and also somewhat terrifying – with the first entry in 2017, when Uber was talking about having an “intra-urban flying vehicle network” available in 2020, with Dallas and Fort Worth being its target. Didn’t quite work out the way they envisioned – they’re now talking 2023 as a more realistic date – but that’s the way it goes. This particular model is basically a car with retractable wings; other models we have heard about include flying motorcycles and something that looks like a drone capable of carrying multiple humans. That latter model is likely a few more years off, but who knows with any of this.

There are a lot of concerns about these things, including noise, safety, and of course the climate effect, but so far that hasn’t stopped anyone from trying. As with driverless cars, which are still in their infancy and still have some major engineering challenges to solve, I think it’s a matter of when and not if for these things. We ought to at least think about how we want to integrate them into society, rather than react when they do show up. You can see more pictures and videos for this particular flying car at the Klein Vision website. CNet and Yahoo have more.

Kids still get COVID, too

And they need to get vaccinated if at all possible.

Since the Food and Drug Administration approved emergency use of the Pfizer vaccine for 12 to15 year olds on May 10, more than 300,000 Texas adolescents and teenagers have received at least one dose. Girls in this age range are receiving the vaccine at a higher rate (153,000) than boys (149,000), according to Texas Health and Human Services. Nationwide, more than 626,000 12 to 15 year olds have received two doses, according to the CDC.

Though young people can now receive shots, the number of children and adolescents being hospitalized is increasing. The Centers for Disease Control and Prevention released data from the first half of 2021 that shows nearly one-third of adolescents who are hospitalized with COVID-19 require intensive care. Five percent of those patients need to be put on ventilators with supplemental oxygen, as well.

The CDC reports that nearly 400 children and adolescents are currently in hospitals across the country with COVID or complications from the virus. More than 16,000 under the age of 18 have been hospitalized from COVID since the start of the pandemic, and more than 300 of them have died from it, said Dr. Jim Versalovic, interim pediatrician-in-chief at Texas Children’s Hospital.

“This is a huge setback for a child or adolescent with time spent out of school or activities,” Versalovic said. “There’s a long recovery time even if the infection is mild initially.”

He attributes the increase to fewer masks and stagnating vaccination rates.

More than half of all Texans are vaccinated with at least one dose, but that doesn’t mean Houston is free of several coronavirus variants that are more transmissible and deadlier than the original virus.

In the last month, fewer people are masking up in public outdoors and indoors after the CDC said it was safe for vaccinated people to go masklessThree-day holiday weekends and the onslaught of summer weather has turned Houston into the partying swamp city it was before the pandemic, too.

[…]

Versalovic said about 10 percent of children diagnosed with the virus at his hospital require hospitalization. This rate is nearly three times greater than the seasonal flu, which the CDC reported killed nearly 600 children between 2017 and 2018.

Child survivors sometimes have a whole new set of problems when the initial infection clears. Several weeks after other symptoms have gone away, children who had mild COVID develop other symptoms that typically require hospitalization. This is called Multisystem Inflammatory Syndrome in Children, or MIS-C.

MIS-C symptoms include fever, stomach pain, diarrhea, vomiting, neck pain, random rashes and bloodshot eyes. Extreme fatigue is also a symptom, but it’s usually blamed on other problems.

Texas Children’s has vaccinated more than 18,500 12 to 15 year olds since early May. Any person age 12 and older is eligible for a free Pfizer vaccine from the hospital, regardless of whether they are currently a patient. Vaccines are available at six Texas Children’s sites across Houston Monday through Saturday.

The hospital is partnering with Houston-area school districts now to immunize their students, so middle and high schools can open safely for the fall semester, he added.

“We are going to be very busy during the summer months as we seek to immunize as many children as possible,” Versalovic said. “It’s important to protect adolescents to stop the spread of COVID as they get ready for summer activities, camps, sports and the school year in August.”

Not much to say here that we haven’t said already, many times. Get your kids vaccinated. As long as there are unvaccinated and/or immunocompromised members of your household, you should continue with pre-vaccination safety protocols as much as possible, which I know is vastly more difficult now that masks are being removed all over the place. It is true that the health risks to kids from COVID are lower than they are with adults, but they are not zero and they can be serious. For all the progress we’ve made, we’re not out of danger yet.

The COVID wastewater tracking project has been a big success

This has been one of the best things to come out of this interminable and miserable COVID experience.

Lauren Stadler’s environmental engineering students always pose the same question at the beginning of a semester: “What happens to water in the toilet after you flush?”

Historically, humans have worked to quickly dispose and eradicate their own waste, which can carry diseases.

But an area’s waste creates a snapshot of who is there and what they’ve been exposed to, said Stadler, a wastewater engineer and environmental microbiologist at Rice University. She’s working with the Houston Health Department and Baylor College of Medicine’s TAILOR program to find SARS-CoV-2 in the city’s wastewater.

Stadler’s hunt has revealed variants in particular areas, heightening the city’s urgency to procure resources — COVID tests, informational meetings, advertising and now vaccine sites — in an effort to quash them before they proliferate.

“The beauty and challenge of wastewater is that it represents a pool of sample — we’ll never get an individual person’s SARS-CoV-2 strain, but a mixture of everyone in that population,” Stadler said. “We can find a population level of emergence of mutations that might be unique to Houston.”

[…]

Variant tracking has become an important part of the wastewater analysis process, Stadler said.

In February, the city and its research partners began seeing a quick emergence of the B.1.1.7 variant, which is now the dominant variant in the area. According to the Centers for Disease Control and Prevention, nearly 21,000 cases of the B.1.1.7 variant have been detected in nationwide.

Now that the team has gathered data and built a sustainable process, Stadler said they are using this information to forecast future pandemics. “Taking wastewater data, you can predict positivity rates and forecast infection burdens — it has this predictive power essentially. It’ll be very important to identify areas in the city experiencing increases in infection, and we can direct resources.”

The wastewater analysis team works with public works employees to collect weekly samples from nearly 200 sites across the city.

“I think they see this as a monitoring tool beyond the pandemic, and we see it as well,” Stadler said. “Hopefully, when SARS-CoV-2 is behind us, we will be able to monitor for an endemic virus, like flu. We can use wastewater monitoring to look for other viruses, bacterial pathogens and other pathogens of concern.”

See here and here for recent entries. I don’t have much to add, just my admiration for everyone involved and the knowledge they have gained. This was a simple and inexpensive innovation, and it will yield public health benefits for years to come. Kudos to all.

Houston Methodist tells its employees to get vaxxed or else

I’m okay with this.

Four out of five Houston Methodist employees are vaccinated against COVID-19. The sliver who are not will be suspended or fired if they refuse the shot, according to company policy.

The hospital required managers to be vaccinated by April 15 and all other employees — about 26,000 workers in total — by June 7, said Stefanie Asin, a Houston Methodist spokesperson.

With 84 percent of the staff vaccinated, the hospital is close to herd immunity, CEO Marc Boom wrote in a letter to employees this month.

“As health care workers we’ve taken a sacred oath to do everything possible to keep our patients safe and healthy — this includes getting vaccinated,” Boom wrote.

A little more than 4,100 employees have not received at least a first dose of the COVID-19 vaccine. The hospital does not know yet how many employees potentially will be suspended or terminated because of the mandatory vaccination policy.

Since 2009, a hospital policy has mandated its workers receive the flu vaccine each year, unless they have a medical or religious objection qualifying them for exemption.

[…]

Several nursing homes in Houston are requiring COVID-19 vaccinations of their workers, while other hospitals in the Texas Medical Center have not yet followed suit.

“UTMB is not mandating vaccination,” said Christopher Smith Gonzalez, senior communication specialist for the hospital. “But, in view of the high contagiousness of the some of the SARS-CoV-2 variants, UTMB has implemented enhanced respiratory precautions for all unvaccinated individuals caring for or evaluating patients for COVID.”

While 80 percent of Texas Children’s Hospital employees are vaccinated against COVID-19, the hospital does not require inoculation. St. Luke’s Health has vaccinated “thousands of our staff,” vaccinations are not mandatory, according to the health system.

But some are considering it to cut back on health hazards for employees and patients.

“As a provider of health care services, Baylor College of Medicine currently requires vaccination for employees for a variety of infectious diseases,” said Dr. James McDeavitt, senior vice president of Baylor College of Medicine. “For example, flu vaccination for employees has been mandatory for several years. With appropriately defined exemptions (medical contraindications, religious beliefs), we support mandatory vaccination for COVID-19. We do not yet have this requirement in place, but it is under active consideration.”

Memorial Hermann will make COVID-19 vaccines mandatory after it relaxes some of its COVID-19 protocols, such as mask-wearing and social distancing. However, it has not set a deadline for employees to receive the vaccine, said Drew Munhausen, a Memorial Hermann spokesperson.

This all makes sense to me. They’re health care workers, which not only makes them at high risk for catching COVID, it means they’re in very close contact with a lot of extremely vulnerable people as well. The story notes a recent incident in a Kentucky nursing home, where an unvaxxed worker was the cause of an outbreak. While most of the residents, who had been vaccinated, had only mild symptoms, one of them died. None of that should have happened. State law requires that health care facilities have a policy about vaccinations, but doesn’t require that they mandate them; federal law allows employers to require vaccinations, but also doesn’t mandate it. I for sure would want to know that the doctor or nurse or physician’s assistant who is giving me medical assistance, as well as all of the support staff, have been vaccinated for COVID. I understand that some of the employees may be hesitant about the vaccine, and I have some sympathy for them, but only so much.

There is also this:

Houston Methodist was one of several companies to offer incentives for its workers to get a COVID-19 vaccine. The hospital is granting $500 bonuses to anyone who worked during the pandemic and received the vaccine.

“Already we’re seeing positive results as the number of employee infections has dropped inversely with the number of employees receiving the vaccine,” Boom wrote.

Paying people to get vaxxed has its merits. One of the hesitant Methodist employees from the story says that some of her fellow hesitators are thinking about getting the shots to keep their jobs. Clearly, incentives work. Maybe that’s a lesson for us for the broader issue.

You will eventually need a COVID booster shot

Just get used to the idea.

More than 28 percent of Texans 16 and older are now fully vaccinated against COVID-19, having received either one shot of the Johnson & Johnson or two of Moderna or Pfizer. But as scientists continue to study the virus and emerging variants, they’re concluding that even the fully vaccinated may need booster shots to stay protected.

“It might be necessary because of waning immunity,” said Dr. Wesley Long, an infectious disease expert at Houston Methodist Hospital. “It might be necessary if we have a variant strain of COVID that maybe the original vaccines doesn’t protect against as well.”

So far, it’s looking probable people will require a booster shot around the holiday season. But there are still many unknowns.

Although the coronavirus pandemic has ravaged the globe for a year now, clinical trials for the vaccine haven’t been around as long. The most recent data from vaccine manufacturers show that the shots offer at least six months of protection, but researchers won’t know until the end of the year whether immunity lasts a full 12 months.

[…]

To test whether patients have lost protection, public health agencies and vaccine manufacturers will likely keep a close eye on the rate of hospitalizations and deaths. If people lose immunity, it’ll likely taper off gradually rather than come to an abrupt end.

“One of two things can happen: We may lose protection against all COVID-19 symptoms, the mild and the severe, which would be a problem, right?” said Dr. Hana El Sahly, an associate professor of molecular virology and microbiology at Baylor College of Medicine. “Or it might be that we only lose protection against the mild symptoms, but retain protection against the severe symptoms.”

Researchers are still studying how SARS-CoV-2, the virus that causes COVID-19, is similar to other respiratory illnesses. While the disease has drawn some comparisons to influenza strains, the vaccines may work differently than flu shots, which require new vaccines every year to fend off emerging strains.

Even if the COVID-19 vaccine goes the way of the flu shot, experts say it’s not a bad sign.

“People shouldn’t be surprised, and it doesn’t mean that the original vaccines are a failure at all,” Long said. The vaccine will still keep people from dying and help them avoid the hospital.

Yeah, I’ve seen news stories about the likelihood of needing annual COVID shots, like one needs annual flu shots, for some time now. One reason for this is that there are new variants emerging with regularity.

College Station is best known as the home of Texas A&M University, but as of this month, researchers have confirmed it’s now the birthplace of a new COVID-19 strain.

Only one student has tested positive for BV-1, named for the Brazos Valley. They were diagnosed with COVID-19 on March 5 and experienced mild respiratory symptoms. A second test on March 25 turned up positive results, worrying researchers the variant would cause a longer infection in young adults.

“We do not at present know the full significance of this variant, but it has a combination of mutations similar to other internationally notifiable variants of concern,” Ben Neuman, a Texas A&M virologist, said in a statement. “This variant combines genetic markers separately associated with rapid spread, severe disease and high resistance to neutralizing antibodies.”

Viruses mutate, it’s what they do. So far, the known variants have all still been controlled by the existing vaccines, but eventually one or more of them will be more resistant. As long as there continues to be a significant population of people who wish to be a reservoir for the virus (read: anti-vaxxers), the virus will have plenty of opportunity to do its thing. As for the rest of us, vaccinations are all around us.

Walk-in COVID-19 vaccine clinics are now all the rage in Houston, as larger allocations and dwindling demand change the scarcity-fueled dynamic of the past several months.

“Now, there is more supply than there is demand,” said Harris County Judge Lina Hidalgo during a Monday afternoon news conference at NRG Park. “That means we have more vaccines than we have people willing to get them.”

As of Monday, 44 percent of Texans have received at least one dose of the COVID-19 vaccine. In Texas, vaccine administration is beginning to plateau at 250,000 doses per day, while vaccine manufacturers produce more doses a week, with 14.5 million shipped nationwide every week as of mid-April.

Harris County’s vaccine site, NRG Park, has abandoned the waitlist system that frustrated residents who found it difficult to schedule a time slot in advance. While the site, run jointly by the county and the Federal Emergency Management Agency, still recommends scheduling an appointment ahead of time to guarantee a dose, anyone age 16 or older can arrive on foot or by car during operating hours for a shot.

In addition, St. Luke’s Health is operating a walk-in clinic at Texas Southern University this week. Michael E. DeBakey Veterans Affairs Medical Center offers walk-up vaccines for veterans, caregivers and spouses.

Get your shot if you haven’t already. Make sure everyone you know gets theirs. And then be ready to do it again, sometime in 2022. This is the world we live in now.

No flu

I would never say that there was any such thing as a silver lining to the COVID pandemic, but it is true that basically nobody died from the flu this year because of masking and social distancing.

What medical officials worried would be a “twindemic” at the end of last year — the concurrence of influenza and COVID-19 sicknesses overwhelming Houston’s hospitals — turned out surprisingly well.

At Memorial Hermann, just three patients tested positive for influenza during the 2020-2021 flu season, compared to 983 patients during the 2019-2020 flu season. Doctors test for both flu and COVID-19 as a precaution.

The same public health measures that prevent SARS-CoV-2 from spreading — masks, social distancing and regular hand-washing — kept influenza strains from sickening people.

“When we were looking internally, we just weren’t seeing flu,” said Dr. James McCarthy, chief executive physician at Memorial Hermann.

Flu infections are down nationwide, with a hospitalization rate of 0.7 per 100,000 people, according to the Centers for Disease Control and Prevention. During the last flu season, the rate was nearly 100 times higher — 66.1 per 100,000 patients. Pediatric deaths also decreased, from 189 last year to one this year.

[…]

Researchers wondered whether being infected with the coronavirus would wipe out the chances of getting the flu, and say it may be a factor that contributed equally to declining flu rates.

“Part of it is because we had a worse virus that was spreading faster,” McCarthy said.

Knowing to wear masks and get a flu vaccine could be a huge step toward eradicating deadly flu seasons. But will people continue to practice those public health measures? Doctors don’t know.

“We’re recognizing that not only can we protect our friends and loved ones from COVID, but we can also do it from influenza with precautions for medically vulnerable folks,” McCarthy said.

I’ve gotten a flu shot every year for as long as I can remember, and as far as I know I’ve never gotten the flu. I will certainly continue to get those vaccines as before, and I’d strongly consider wearing a mask during the flu season going forward when doing things like grocery shopping. Hard to see any reason why not to at this point.

First look at the 2021 hurricane season

Yeah, it’s getting to be that time of year. From Space City Weather:

Good morning. The most reputable hurricane season forecasting service, led by Phil Klotzbach at Colorado State University, has released its first outlook for the 2021 Atlantic season. The forecast calls for above normal activity (see table below) with 17 named storms instead of the more typical 12; eight hurricanes instead of six; and about 50 percent total more activity, in terms of the duration and intensity of tropical systems, as measured by accumulated cyclone energy.

This outlook is consistent with other predictions, already released, in calling for a busier than normal season. What I like about Klotzbach’s forecast is that he’s very clear about his methodology—using a combination of statistical modeling, and historical correlations between Spring-time weather conditions and hurricane activity later in the year. Klotzbach also has a reasonable track record.

With that said, seasonal hurricane forecasts are far from perfect. I think, generally, we can expect a busier Atlantic season, but we’re almost certainly not going to see a brute of a year like 2020. Moreover, the chance of the Houston area being directly affected by serious tropical weather (in terms of floods, winds, or surge) is pretty low. Historically, the region only sees a significant storm about once a decade or so. Therefore, while it certainly is time to begin planning for the 2021 Atlantic season, I very much do not want you to start worrying or obsessing about it. Matt and I will, of course, be here every step of the way, and we’ll be releasing a new app before the June 1 beginning of the season to keep you informed.

“Not as bad as 2020” is a low bar to clear, but we have to start somewhere. There will be other forecasts, and that will give us a fuller picture of what is expected. Also of importance is predicting the development and path and severity of hurricanes and big rainstorms, and towards that end the NOAA rolled out a new model last month.

“You just get a better forecast,” said Lance Wood, a meteorologist with the National Weather Service’s Houston/Galveston office. “The day-to-day reliability of the model forecasting would be better, though it would probably be more noticeable in something like an extreme rainfall threat.”

The upgrades include a variety of changes. For one, the Global Forecast System (an atmospheric model) can now interact with a global wave model. Running these models together will extend wave forecasts to 16 days, up from the current 10-day forecasts. This is particularly helpful to mariners planning long-distance voyages, Wood said.

The upgrades also provide a more detailed look at the atmosphere at various vertical levels. Previously, the model showed data at 64 different levels in the atmosphere. Now, it will show 127 different levels. This type of information can help provide more accurate cloud coverage forecasts — a weather outlook that’s often requested by general aviation pilots who want to know how thick the clouds will be.

And finally, the new-and-improved Global Forecast System will be able to pull more data from satellites that provide weather observations and planes that measure wind, temperature and moisture, Wood said.

In other words, we’ll have more time in advance of a hurricane to know that it’s coming and to prep for it. We need all the help we can get with that. Stay alert, be prepared, don’t panic, and we’ll get through this.

What to expect when you’re fully vaccinated

The CDC has released some guidance that will help people understand what is safe to do and what precautions they will still need to take once they are fully vaccinated.

Fully vaccinated Americans can gather with other vaccinated people indoors without wearing a mask or social distancing, according to long-awaited guidance from federal health officials.

The recommendations also say that vaccinated people can come together in the same way — in a single household — with people considered at low-risk for severe disease, such as in the case of vaccinated grandparents visiting healthy children and grandchildren.

The Centers for Disease Control and Prevention announced the guidance Monday.

The guidance is designed to address a growing demand, as more adults have been getting vaccinated and wondering if it gives them greater freedom to visit family members, travel, or do other things like they did before the COVID-19 pandemic swept the world last year.

“With more and more people vaccinated each day, we are starting to turn a corner,” said CDC Director Dr. Rochelle Walensky.

During a press briefing Monday, she called the guidance a “first step” toward restoring normalcy in how people come together. She said more activities would be ok’d for vaccinated individuals once caseloads and deaths decline, more Americans are vaccinated, and as more science emerges on the ability of those who have been vaccinated to get and spread the virus.

You can see their guidance here. Among other things, this should make a lot of grandparents happy:

A lot more people will get those vaccines in the coming weeks. The need for continued mask-wearing is simply because you can still get and carry the SARS-CoV2 virus after being vaccinated, you are just much less likely to become sick if you do. Basically, you can still be an asymptomatic carrier, and so for the safety of the not-yet-vaccinated, especially in public places, your mask is still needed at this time. But that will eventually decrease, as the vaccination numbers swell. We just had to wait a little longer. We can and must still do the right thing in the meantime. Vox, the Chron, and Daily Kos have more.

Memorial Hermann CEO begs for Abbott to reconsider maskless mandate

He won’t listen, but maybe some of the people who would have stopped wearing their masks will.

On March 2, Gov. Greg Abbott announced the issuance of a new executive order, which “re-opens” Texas. The new order, which takes effect Wednesday, March 10, also terminates the statewide mask mandate.

As a health system, we respect the governor and recognize that he has an incredibly difficult job right now; however, we disagree with the terms and the timing of this new order, and strongly encourage him to reconsider this decision.

[…]

Additionally, we are deeply concerned about the timing of this decision, especially as we have just learned that all of the major new COVID-19 variants, which seem to be more dangerous and more transmissible, have now been identified in Houston; in fact, we are the first major U.S. city to confirm that all of these new variants are active in our community. Even more, for the first time in many weeks, the number of new cases reported around the world is higher than it was a week ago. Finally, we are gravely concerned that upcoming Spring Break gatherings will result in surges similar to those caused by holiday get-togethers, or worse.

The pandemic is not over, and our safety measures should not be, either. We hope that by continuing to practice the proven safety measures and encouraging others to do so as well — and as more and more people in the greater Houston area become vaccinated — we can happily support lifting masking restrictions in the future, maybe even as soon as several months from now. But we feel that issuing this order at this time, considering the current environment, is premature. In the greater Houston area, it is clear that COVID-19 is not yet under community control.

You may think this is not particularly remarkable, but hospital bigwigs have tried very hard to stay out of political fights surrounding COVID:

And as for that mention about COVID variants in Houston, consider this:

Read that whole thread and maybe be a little scared. Definitely keep your mask on, and stay away from any business or other indoor location that doesn’t require masks. If we truly are on our own, we’ve got to take this a lot more seriously than Greg Abbott does.

Let me Google that vaccine locator for you

Good.

In the coming weeks, Google will begin implementing a vaccine locator service on its platforms for Texans to use, including appointment details, clinic hours and more.

The rollout comes as part of a $150 million plan announced by Google in late January for vaccine education and accessibility. Included in this plan are vaccination site location services for Texas, Arizona, Louisiana and Mississippi, as well as plans to open vaccination sites as needed.

“Searches for ‘vaccines near me’ have increased 5x since the beginning of the year and we want to make sure we’re providing locally relevant answers,” Google CEO Sundar Pichai said in a release.

Information for the vaccination locator will be pulled from government agencies, pharmacies and VaccineFinder.org to provide users with detailed assistance.

The plan also includes grants distributed to public health agencies and organizations assisting marginalized individuals with vaccine access.

You can read the full release here. This does seem like the simplest answer to the problem, but it did need for there to be consistent data out there about where to find vaccines in the first place. Now you won’t have to know where to look for that, you can just search as you normally do. Or at least you will in the coming weeks. That should help a lot.

Here comes the vaccine

Houston’s first doses have arrived.

Months of waiting for a COVID-19 vaccine to arrive in Houston are almost — but not quite — over, as hospitals prepare to move the first doses from sealed subzero shipments and into the arms of thousands of front-line health care workers this week.

About 19,500 doses of Pfizer’s vaccine will arrive Monday at four medical centers in Texas: MD Anderson Cancer Center in Houston, Methodist Dallas Medical Center, Wellness 360 at UT Health San Antonio and UT Health Austin’s Dell Medical School, according to the Texas Department of State Health Services, which is overseeing deliveries of the first vaccine approved and shipped in the United States.

Another 75,075 doses will arrive at 19 additional sites on Tuesday, including seven in the Houston area. By midweek, 27 hospitals in the Houston region, most of them Texas Medical Center hospital system flagships or suburban campuses, will have received doses.

Officials on Sunday at some Houston hospitals compared it to waiting on an Amazon delivery: The package is confirmed, but the email with the tracking number and details hasn’t arrived. The first inoculations in Houston could happen in days, depending on when those shipments appear, said Dr. Marc Boom, president of Houston Methodist.

“If it arrives tomorrow, we will have a full day of vaccinations on Tuesday,” Boom said Sunday. “If it’s Tuesday, depending on what time, we could have some people come in. … I have people scheduled literally in five-minute slots.”

[…]

Under a tiered plan developed by public health leaders, the first vaccine doses will be given to front-line hospital workers. Later shipments will allow hospitals to administer doses to patients at high risk of contracting COVID-19 and developing serious complications, likely in January.

And after that it gets trickier. And it could get even trickier still.

Here are some basic outlines of what’s happening. As we learned last week the Trump White House skimped on actually buying enough doses of vaccine from Pfizer. But the federal government will cover the actual purchase of vaccines. The White House says the military is in charge of and has a plan to actual get the supplies to the states. And though we don’t know all the details let’s assume they have that covered. But that only appears to be getting the crates of supplies to a central staging point in each state. That’s not a negligible job. But it’s only a relatively small part of actually getting the country vaccinated. You need public health campaigns. You need staging areas and distribution from wherever the military drops it off to actual health centers and vaccination centers around each state. And finally you need a small army of medical professionals to actually administer the doses. It’s a big job and the Trump administration hasn’t funded any of that or devised any national plan.

In the absence of any federal plan or budget the CDC and HHS have cannibalized existing budgets to get some money to states for planning. But the sums are by most estimates an order of magnitude less than the amount needed.

State governments would be hard pressed to fund an operation like that during the best of times. But states and local governments around the country are already pushing massive cuts because of the dislocations caused by the pandemic. Through much of the latter part of 2020 the assumption was that this would be dealt with in a follow-up stimulus plan. But of course that never happened.

What the White House has arranged funding for is a critical but relatively small part of the vaccination effort: vaccinations for people in assisted living facilities and health care workers. Those are the two most critical populations. They should go first, and the plan is to get those people vaccinated in December and January. But that leaves the great bulk of the population unvaccinated. The plan is for that phase to end around Feb 1. Meanwhile CARES Act funding, which states can use for various purposes, has to be spent by Dec. 31.

That’s all that’s funded. It’s like a trap door set up for Biden to fall through. So as you can see, today’s excitement and anticipation over the vaccine is cued up to turn sharply to disappointment in February when people start asking where their shots are and blame the train wreck on President Biden. No plan. And no funding to implement a plan. Of course that is potentially catastrophic in human terms. But a lag in vaccination means not only more suffering and death but more delay in allowing the economy to get back on its feet, since people aren’t going to go to restaurants and participate in public life until case numbers drop dramatically.

That…would be bad. I suppose as long as there are still talks for another COVID relief bill, or if Dems win both Georgia Senate runoffs, we still have hope. But yeah, that could be a problem.

Also a problem:

The White House Coronavirus Task Force is increasingly suggesting that states including Texas begin shutting down again, saying in reports sent to state leaders this month that they aren’t doing enough to slow the worst surge in COVID cases that the country has seen.

“This surge is the most rapid increase in cases; the widest spread of intense transmission, with more than 2,000 counties in COVID red zones; and the longest duration of rapid increase, now entering its 8th week, that we have experienced,” say the reports, sent to Texas and other states on Dec. 6. “Despite the severity of this surge and the threat to hospital systems, many state and local governments are not implementing the same mitigation policies that stemmed the tide of the summer surge; that must happen now.”

Texas, the report says, “must increase mitigation to prevent ongoing community spread,” including “significant reduction in capacity or closure of public and private indoor spaces, including restaurants and bars.”

The task force’s reports over the last several weeks, meanwhile, have consistently pointed to the success of European countries — many of which have shuttered restaurants, bars and other businesses — in stemming the outbreak.

“The majority of the United States is not mitigating similarly,” Dec. 6 state report says.

You know how I feel about this. Do your best to take care of yourself, because Greg Abbott isn’t going to do anything to help you. The Trib has more.

The COVID breathalyzer test

Sounds promising.

Texas A&M researchers and a Dallas artificial intelligence company are developing a rapid COVID-19 test that would use a breathalyzer, rather than a swab, and potentially make it safer to hold large gatherings.

The testing device, housed in a kiosk that can fit in the back of an SUV, could be set up outside of large group settings such as schools, churches and corporate offices.

People would step up to the device and, with a disposable straw, blow into a copper hole on the front of the kiosk.

The system captures the user’s breath and analyzes it for compounds that a body generates when it’s fighting SARS-CoV-2, the virus that causes COVID-19. Users would receive the results within a minute of the test through a mobile app.

“It’s all about establishing a controlled environment where people can interact and have confidence about it,” said Rob Gorham, executive director of SecureAmerica Institute, a network of public institutions and private manufacturing and technology companies based at Texas A&M. “It can create more normalcy around establishing these trusted group settings, whether it be an airplane or a football stadium.”

The device, called Worlds Protect, is a collaboration between Texas A&M researchers, who developed the hardware for the testing systems, and Worlds Inc., which developed the artificial intelligence software.

Here’s a story on Texas A&M’s website about the development. They’re waiting for FDA approval, and could start manufacturing the devices as soon as March. The devices cost about $5,000, and each test costs less than fifty cents, so it would be reasonably cost effective for, say, a pro sports team or stadium to buy a few and use them as a prerequisite for attending a live event. I would hope that the test is aggressive about flagging questionable results – the default should be “go get yourself a real test”, so that there are essentially no false positives. Better to turn away a hundred COVID-free people than to let one COVID-positive person in the door. If this fulfills its promise, it’s a big step in the direction of returning to “normal”.

“COVID-killing machines”

I like the sound of that.

The George R. Brown Convention Center was built to hold Houston’s biggest crowds, but during the pandemic its halls have grown quieter. In reviving the center, Houston First squared off with a problem facing all local venues — showing the public they’re safe.

To address the problem, the local government corporation created to operate the city’s convention and performing arts facilities launched a public education campaign in August and spent about $30,000 on three mobile air filtration units for the convention center’s general assembly space, which is often used by businesses for presentations. The units, installed in September, add a layer of security for guests, said Michael Heckman, the group’s acting president and chief executive.

“Any level of added confidence that we can give to the public during this time is incredibly important,” Heckman said. “And I think once people understand the level of sophistication of this technology they’d be highly impressed, as we were.”

The filters are the product of Houston’s Integrated Viral Protection, an enterprise formed by engineer and real estate developer Monzer Hourani based on technology developed by researchers at the University of Houston.

[…]

Other pandemic-era inventions, such as UV light devices, require people to leave the room and, while they kill viruses on surfaces, they are not as effective at treating the air, Hourani said. Most HEPA, or high-efficiency particulate air filters, remove particles through holes still big enough to let coronavirus through, he said.

Despite the creation, Hourani said people gathering still need to wear masks. From a clinical perspective, air filtration devices like IVP’s can be used as an added layer of protection in addition to other preventative measures, said Dr. Jill Weatherhead, assistant professor of infectious disease for Baylor College of Medicine.

“At this point it’s unclear how much benefit it provides,” she said, “and it shouldn’t take the place of mask-wearing and social distancing. And frequent disinfecting.”

Most of what’s in between is technical details about the filters and the company, which you can peruse as you see fit. I think the idea of “making it safer for people to congregate indoors, as long as they wear masks” is a good one, and if it works would allow for a greater resumption of normal activities, without increasing the risk. It’s pretty clear that there are a lot of people who can’t or won’t do the risk-mitigating things we need them to do – and let’s be clear, some of these folks are service and retail workers who have no choice, while some others very much could be making different decisions – and as long as that is the case, the next best thing we can do is improve the odds overall. I hope this works as intended.

A new way to deliver rural Internet access

Pretty cool.

From his 500-acre spread in Paige, just 50 miles east of Austin, Francisco Artes can send an email, check a website or two and conduct a chat session.

But there are some days when streaming video or participating in a teleconference is out of the question. Like a lot of folks with homes and businesses in rural America, Artes struggles with his internet connection – and really, he’s lucky to have one at all.

“We get maybe 1 (megabits per second) uploads, maybe 10-12 (Mbps) downloads,” he said. “It’s really hit or miss whether you’ll have a good Zoom call.”

Artes’ primary internet service uses a form of WiFi, beamed to an 80-foot tower on his land, where he operates a winery and a festival site. He’s supposed to be getting 25 Mbps for both downloads and upload.

Help may soon be on the way. Artes is testing a new kind of internet service being developed by a Houston startup called Skylark Wireless. It turns the unused frequencies normally associated with television stations into internet service, and it’s seen as a real possibility to get high-speed data service to people in rural areas who’ve had to do without for decades.

Known as TV white space technology, or TVWS, it already has sold Artes, who is now able to join those Zoom teleconferences without missing a beat.

“We’ve gotten speeds that at times were mind-boggling for out here in the country,” Artes said, adding he’s getting 30 megabits a second for both download and upload speeds. “We can’t wait we can start using it commercially.”

That could happen as soon as the end of this year or early next, say Skylark co-founders Ryan Guerra and Clayton Shepard. The company, which will license its technology to rural internet service providers, already has customers lined up to deploy it.

[…]

While other companies are using TVWS to do rural broadband internet access, Skylark’s approach is unique. It uses software-enabled radios that can be programmed to run on different frequencies, making the tech less expensive to configure and change as conditions and customer needs warrant.

Guerra, the CEO, and Shepard, the chief technical officer, say the same signals used for television are perfect for getting internet access to people in out-of-the-way places.

“The low frequencies in TV that are occupied by television broadcasters allow (the signal) to go much further and propagate through trees, buildings, materials, very well compared to other bands,” Guerra said. “In rural areas, the main challenge is to provide connectivity to people that are spread so far apart and in such difficult terrain. You have all the same challenges that television broadcasting has already solved: Getting through trees, going long distances, etc.”

That makes the signals that TV uses so valuable that they are referred to as “beachfront spectrum.” The Federal Communications Commission has allowed it to be used for data when it’s not being used for television, for the express purpose of solving the problem of getting internet access to rural areas.

In a city the size of Houston, there are literally dozens of television stations operating on many different channels. But out in the country, there may be only a few that can be received by TVs in any given area. The other channels go unused, which is why they are referred to as “TV white space.”

For example, Shepard said that Francisco Artes’ test setup is receiving internet service on what would normally be channels 53 or 58. Those channels are actually licensed for use in the area, but currently are not occupied. With permission from the holder of the frequencies – in this case, Lowell Feldman, a Skylark investor and CEO of wireless service provider Evolve Cellular – the startup is allowed to test on them.

True “white spaces” are frequencies that are unlicensed, and when Skylark Wireless goes commercial, it will be moving the technology to use those bands. That requires an FCC certification.

There’s more, so read the rest. Skylark is a Houston company with connections to Rice University. As the story notes, there are 21 million Americans (or more, depending on how you do the estimate) that lack broadband Internet access. This approach solves a lot of the technological challenges, which in turn should make it cost-effective. The big cellular companies are looking at this space as well, so perhaps there will be a viable solution soon. Given the need for remote learning and e-commerce these days, that can’t happen soon enough.

Mutant mosquito update

Keeping you informed on the news you can really use.

Four years ago, the Zika virus became an issue. More than 300 people were infected in Texas. Zika can cause birth defects and fetal neurodevelopmental abnormalities in pregnant women.

The vector is Aedes (rhymes with ladies) aegypti and Aedes albopictus mosquitoes. The Aedes mosquitoes transmit Zika, chikungunya, dengue and yellow fever, which prompted state and county health officials to discuss actionable solutions to control the mosquito.

Talks about releasing genetically modified mosquitoes in Houston began in 2018 between Harris County and Oxitec, a United Kingdom-based company that produces sustainable technologies or transgenic methodologies to stem the impact of disease-spreading insects. Talk also began about a similar action in Monroe County, Fla.

However, ecological concerns have been raised about the use of these mosquitoes.

“We had stakeholders there who wanted to use it,” said Kevin Gorman, head of field operations at Oxitec. “We had vector control authorities who were keen to try the technology.”

The Environmental Protection Agency stated in a May 2020 press release that it approved an experimental use permit to Oxitec to field-test its genetically engineered mosquito in the United States.

The genetically modified Aedes aegypti mosquitoes are males that mate with wild female Aedes aegypti, essentially causing the offspring to die before they can reproduce due to a genetic variation.

Oxitec had two successful years of controlling the Aedes aegypti in Brazil with its current generation of mosquito and had several years of efficacy in Brazil with its first-generation, Gorman said.

[…]

A release in Florida seems imminent, but not in Texas. Despite an established relationship and much communication, it looks like the Florida Keys will be going solo.

“Although we really enjoyed a sort of really great relationship with Houston at the moment we’re in a holding pattern with Houston,” Gorman said. “And we’re unlikely to be releasing there, and there certainly aren’t firm plans to do so in the next year.”

He cited uncertainty due to personnel changes in the county government as the reason for the decision.

A statement sent to Reform Austin by Sam Bissett, a communications specialist with Harris County Public Health, said the choice to not move forward with the release was made last year by both parties.

“At this time, there are no agreements or approval in place for Harris County to work with Oxitec in 2021. While we have had discussions with Oxitec previously about a potential partnership with Harris County Public Health, those discussions were paused last year between both sides.”

See here for my previous post on Oxitec and mutant mosquitoes, from 2017. There’s a lot more to the story and it’s hard to just capture the essence of it, so go read the whole thing. Apparently, the Aedes aegypti mosquito is more abundant in the Rio Grnade Valley than in Harris County, so maybe we’re not the best place to test this out in the US. Harris County also employs mosquito traps and dragonfly armies to control the local skeeter population. Which all seems a whole lot more quaint these days, but Zike and its ilk haven’t gone away just because we’re mostly inside these days. We will be spending more time outside again, and when we do we’d like to not be at significant risk from some other emergent deadly disease, thank you very much. Maybe next time we’ll be able to work something out.

Our vaccination rates are down, too

I wish I had a snappy intro for this, but I just don’t.

The summer months are typically the busiest of the year in Dr. Kenya Parks’ office, a steady flow of parents trotting in their little ones to receive immunizations required for school attendance.

But the numbers are way down this year, one more casualty of the COVID-19 pandemic.

“It’s quite noticeable,” said Parks, a pediatrician with UTHealth and UT Physicians, the practice of doctors at the University of Texas’ McGovern Medical School in Houston. “Parents who usually pack our offices around now instead are putting off or canceling or just not showing up for appointments. They’re scared.”

Such fear is a primary reason for an average 44 percent drop in the number of doses administered in the Texas Vaccines for Children program during the early months of the pandemic, according to a new state report. The trend puts Texas at risk of vaccine-preventable disease outbreaks, a potential disaster when school starts up.

The drop is particularly high for immunizations for measles — 55 percent — the highly infectious disease declared eradicated in the United States 20 years ago but now experiencing a resurgence. The drop in doses administered is slightly higher in the Houston area, site of a measles outbreak in 2019 and identified in a study the same year as one of the nation’s hot spots, vulnerable to an even bigger outbreak.

The overall Texas trend is concerning because the state’s vaccination rates were bad even before the pandemic. The state last year failed to meet minimal national goals for eight of 11 immunizations and barely squeaked by for the three it did meet.

“It’s like we got an F in eight classes and a D- in three, and now things are getting worse, when we can least afford it,” said Allison Winnike, president of the Immunization Partnership, a Houston-based vaccine advocacy organization. “That’s why it’s crucial parents call their pediatricians, get their kids in for their vaccinations if they’re not up to date.”

The good news, if you want to call it that, is that this doesn’t seem to be the result of changing attitudes about vaccinations. It’s about fear of the virus, which is something we can be a bit more hopeful will change in the not-too-distant future. But this is also a real risk factor for reopening schools, which I haven’t seen any official acknowledgement of. Risking a COVID-19 outbreak to force in-person school at a predetermined date is bad enough. Risking a measles outbreak on top of that is even worse. You can blame the parents if you want for the decisions they’ve made – I for one would be more compassionate, but you do you – but that doesn’t change the fact that this is a thing that will need to be dealt with, and that’s likely going to require some time. Are Greg Abbott and the TEA even thinking about this?

We need to understand what we did wrong

So yeah, we need this.

Two of the nation’s most influential experts on the coronavirus pandemic, both based in Texas, are calling for an independent, nonpartisan investigation of the U.S. response to the novel coronavirus.

“We must prevent this from happening again,” said Gerald Parker, who directs the pandemic and biosecurity program at Texas A&M’s Bush School of Public Service. “This is not going to be our last pandemic.”

Peter Hotez, a Houston-based vaccine researcher and frequent commentator on cable news, noted that the current virus, SARS-CoV-2, is the third coronavirus to pose a major health threat in the last 20 years. And given that outbreaks had already wreaked havoc in China and Europe, U.S. public health systems were notably slow to respond.

“What hurt Wuhan was what hurt New York City,” said Hotez, “which is that virus transmission went on for six weeks before there was any public health intervention.”

In a videotaped interview with John Sharp, chancellor of The Texas A&M University System, Parker suggested an investigation modeled on the nonpartisan 9/11 Commission.

[…]

Hotez, who also participated in the interview with Sharp, said later that he feared a congressional panel would become “a political circus.” Instead he proposed a review by the National Academies of Sciences, Engineering and Medicine.

Among the questions Hotez wants answered: How, for the whole month of February, did the U.S. miss evidence that the virus was already here? Given the crowding and high number of underlying conditions in low-income neighborhoods, what was done to prepare African-American and Hispanic communities in the early days? Why didn’t the CDC have a centralized epidemiological model, including models of cities and metropolitan areas? And how can the U.S. prepare for future epidemics?

For those who are fans of comparing government to business, this is a very standard business thing to do. Call it an after-action review, or a root cause analysis, or just a plain old audit, it really is vital to learn from experiences, good and bad, so that you can understand what happened and why it happened, and what you can do better next time. I think we can all agree that there is plenty to be learned from this saga, and we all owe it to ourselves to do that. I would hope that much is non-controversial.

But let’s be real, there’s no way to do this that won’t involve politics. You can put together the bluest of blue ribbon panels, staff it with the bona fidiest of experts, and stick entirely to a just-the-facts narrative, it’s still going to be political. That’s because the single biggest actor in this drama was Donald Trump, and his influence on the decisions made at the state and local level was entirely political. Any review that doesn’t do a thorough accounting of this isn’t worth the effort. If Republicans haven’t figured out that Trump’s mishandling of this is what’s killing them in the polls right now, I can’t help them, but I would think they’d want to help themselves. If we manage to get an all-Democratic government next year (please, please), I won’t really expect Republicans to like anything such a report would say. That’s shouldn’t be the point, or anyone’s concern. Do a thorough review, get all the facts out into the open, learn everything there is to be learned, and let the chips fall where they may.

The reopening metric we should be heeding

From Twitter:

Here’s that link:

Abstract

We report a time course of SARS-CoV-2 RNA concentrations in primary sewage sludge during the Spring COVID-19 outbreak in a northeastern U.S. metropolitan area. SARS-CoV-2 RNA was detected in all environmental samples and, when adjusted for the time lag, the virus RNA concentrations were highly correlated with the COVID-19 epidemiological curve (R2=0.99) and local hospital admissions (R2=0.99). SARS-CoV-2 RNA concentrations were a seven-day leading indicator ahead of compiled COVID-19 testing data and led local hospital admissions data by three days. Decisions to implement or relax public health measures and restrictions require timely information on outbreak dynamics in a community.

Introduction

The most common metric followed to track the progression of the COVID-19 epidemic within communities is derived from testing symptomatic cases and evaluating the number of positive tests over time.1 However, tracking positive tests is a lagging indicator for the epidemic progression.2, 3 Testing is largely prompted by symptoms, which may take up to five days to present4, and individuals can shed virus prior to exhibiting symptoms. There is a pressing need for additional methods for early sentinel surveillance and real-time estimations of community disease burden so that public health authorities may modulate and plan epidemic responses accordingly.

SARS-CoV-2 RNA is present in the stool of COVID-19 patients5-7 and has recently been documented in raw wastewater.8-10 Thus, monitoring raw wastewater (sewage) within a community’s collection system can potentially provide information on the prevalence and dynamics of infection for entire populations.11 When municipal raw wastewater discharges into treatment facilities, solids are settled and collected into a matrix called (primary) sewage sludge, which has been shown to contain a broad diversity of human viruses including commonly circulating coronavirus strains.12 Primary sludge provides a well-mixed and concentrated sample that may be advantageous for monitoring SARS-CoV-2. As viral shedding can occur before cases are detected, we hypothesize that the time course of SARS-CoV-2 RNA concentrations in primary sewage sludge is a leading indicator of outbreak dynamics within a community served by the treatment plant.

So in plain English, if you know what the level of SARS-CoV-2 is in your municipal wastewater, you will have a very accurate predictor of the new COVID-19 case rate in your community. And guess what? The city of Houston is tracking this very data. I don’t know if it’s being published anywhere, but it sure could shed some light on how things are really going around here. Other cities should be doing this as well – if they aren’t doing it already, they need to start – and that information should be collected and published at the state level as well. What are we waiting for?

How about some antibody tests?

That would be good.

After months of emphasis on diagnostic screening, contact tracing and research into possible treatments, Houston is about to deploy a new tool in the effort to contain COVID-19: antibody testing.

Baylor College of Medicine researchers last week presented evidence to school leadership that the blood test it developed to detect whether an individual has been infected with the coronavirus is highly accurate and ready for use in studies assessing the virus’ reach in the area. Such studies would provide the answer that hasn’t been ascertainable because of the shortage of diagnostic testing.

“This will tell us the severity of the disease based on prevalence, the number of people who have had the virus but do not show up in case counts because they were asymptomatic and weren’t tested,” said Dr. Paul Klotman, president of Baylor. “That’s needed to better understand how infections impact different Houston communities, the variations in those communities and the numbers in certain high-risk environments, like prisons and nursing homes.”

Klotman said he anticipates Baylor will partner with local health departments to determine optimal resource allocation — such as where to focus testing and contact tracing — based on the prevalence the studies find in communities.

A Baylor prevalence study based on antibody testing would put the Houston region among a handful of U.S. communities to conduct such research, which has found that more than 20 percent of people in New York City but only 4 percent of those in Los Angeles County have been infected. Klotman said he thinks Houston’s rate will be closer to the California number.

Such antibody testing, repeated over time, also would show the area’s progress toward herd immunity, the protection from a contagious disease that occurs when a high percentage of the population has either had the infection or been vaccinated. Experts say that percentage — there is no vaccine for the coronavirus yet — needs to reach at least 60 to 70.

There’s more, and you should read the rest. As a reminder, viral tests are to see who has the virus now, and antibody tests are to see who has had it in the past. Do not mix the two if you want to know the current case count. I would note that the Texas Tribune case tracker showed 10,921 infections in Harris County as of May 25. If that four percent guess is accurate, then given a county population of 4.7 million, the actual number of cases would be more like 188,000. That’s consistent, even a bit under, the typical antibody test experience, which winds up estimating the real infection count at about ten times the “official” count. And note that we’d have to have more than ten times that number to get close to the minimum threshold for herd immunity.

Anyway. I look forward to seeing what this can tell us. In conjunction with the wastewater testing, maybe we can finally get a clear local picture of this pandemic.

Making a better severe storm warning

Of interest.

We’ve all heard them – the blaring alerts that activate our cellphones or television when a severe weather warning is issued.

Perhaps our favorite weather app sent us a push notification, or we saw a television meteorologist pointing at vibrant boxes on a weather map. Whatever the medium, weather warnings have a way of finding us, especially whenever a severe thunderstorm is close by. Now, those warnings, specifically the way in which they’re generated, are in the process of getting a makeover.

Severe weather warnings are issued for individual thunderstorms; before 2007, entire counties would be alerted at once. Over the years, weather warnings have become more targeted – but one warning can still cover an expansive area. Moreover, conditions can vary wildly even within the region enclosed by a single warning.

Now, the National Weather Service is hoping to change that.

Kodi Berry leads the program that’s updating warnings at the National Severe Storms Laboratory (NSSL) in Norman, Oklahoma. The Forecasting a Continuum of Environmental Threats program, or FACETs, is an endeavor the National Weather Service is pursuing to communicate the hazards posed by severe thunderstorms on a hyperlocal level.

Berry says the goal is provide a more continuous flow of information for those who need it the most.

According to the National Severe Storm’s Laboratory, FACETs aims to improve weather watches and warnings to provide “detailed hazard information through the use of ‘threat grids’ that are monitored and adjusted as new information becomes available.”

Typical weather warnings are issued in the form of polygons digitally drawn on a map. If you’re within the polygon, you’re alerted and urged to take action – such as seeking shelter. But just a stone’s throw away, a neighboring home outside the polygon may not be given any special instructions. The current state of weather warnings is binary, akin to a “yes” or “no” to severe weather.

Berry’s team is hoping to improve that by creating a product that reflects the gray area in between. They are experimenting with displaying probabilities to reflect the range of possible outcomes in a rapidly-evolving severe weather event.

“There has been a lot of social science research that shows that, given probabilistic information, people make better decisions,” Berry said. “If we appropriately define these probabilities and what they mean, people can use them to make better decisions.”

See here for more on the NSSL, and here for more on FACETs. I like the idea overall and agree that more precise information that goes beyond the “threat/no threeat” binary makes sense, but I’m not so sure people make better decisions when given probabilistic information. There’s also a lot of research showing that people are not at all good at understanding risk levels, and at least in a political context it’s common to see people round down small-but-not-that-small probability events to “zero”, or the converse to “one”. I’m a fan of more and better data and so I approve of the idea, I just think it’s likely that how this data is presented and explained to the public will need to be refined a couple of times.

TxDOT hit with ransomware

Not great.

Texas’ transportation agency has become the second part of the state government to be hit by a ransomware attack in recent days.

On Thursday, someone hacked into the Texas Department of Transportation’s network in a “ransomware event,” according to a statement the department posted on social media Friday.

The departments’ website says some features are unavailable due to technical difficulties, but it is not clear what functions were affected by the attack. Agency officials did not respond to emailed questions Sunday.

[…]

Upon detecting the hack, staff at the transportation department “immediately” isolated the affected parts of the network and “shut down further unauthorized access,” according to the statement. James Bass, the department’s executive director, said his staff is “working to ensure critical operations continue during this interruption.″ The hacks follow a ransomware attack of unprecedented size that hit more than 20 local governments in Texas last summer.

See here for more on the attack on the court system’s website. In 2019, there was a coordinated attack on the systems of multiple small cities and counties.

I can’t find much in the way of news on this, so here’s TxDOT’s statement, via Twitter:

Maybe these two attacks are unconnected – there’s not enough information, such as what type of ransomware was involved and what the vector for it was, for me to take a guess – but the fact that there were two such attacks in a short period of time on two state systems sure seems suspicious to me. If I were at the state Department of Information Resources, I would be very busy, and more than a little concerned, right now. KXAN, CBS DFW, and Bleeping Computer have more.

Ransomware attack on state court system

Not great.

Websites for the Texas court system were still down Monday after a ransomware attack late last week left the network temporarily disabled, according to the Office of Court Administration.

Officials discovered the breach early Friday and quickly shut down sites and disabled servers to contain it, the office said in a statement. The hack did not impact e-filing and other services, many of which have been transferred to the cloud in recent years, according to the office.

“At this time, there is no indication that any sensitive information, including personal information, was compromised,” the office said. It added that websites for local trial courts are still available online.

The office said it detected the breach early and has refused to pay any ransom. While the courts have moved increasingly to remote hearings amid the coronavirus pandemic, the attack was unrelated, according to the office.

Officials have not said when the system will be back online, but they have set up a temporary website and are working with law enforcement and the Texas Department of Information Resources to investigate the attack.

As the story notes, this is not the first time that Texas governmental entities have been targeted by ransomware. The first thing that TDIR will need to figure out is whether this was actually targeted, or just a crime of opportunity, perhaps the result of someone opening a phishing email. If you follow this sort of news, you know that ransomware attacks are on the increase around the world; here’s a prominent recent example. I’m sure the system will recover from this, and good for the OCA if they detected it quickly. We just need to up our vigilance and defensive measures to stay on top of this.

Are we sure we’re using the right models?

Let’s check our assumptions before we do anything dumb.

Be like Hank, except inside

A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.”

“It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington.

Others experts, including some colleagues of the model-makers, are even harsher. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.”

The IHME projections were used by the Trump administration in developing national guidelines to mitigate the outbreak. Now, they are reportedly influencing White House thinking on how and when to “re-open” the country, as President Trump announced a blueprint for on Thursday.

The chief reason the IHME projections worry some experts, Etzioni said, is that “the fact that they overshot” — initially projecting up to 240,000 U.S. deaths, compared with fewer than 70,000 now — “will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place.”

That could produce misplaced confidence in the effectiveness of the social distancing policies, which in turn could produce complacency about what might be needed to keep the epidemic from blowing up again.

[…]

“This appearance of certainty is seductive when the world is desperate to know what lies ahead,” Britta Jewell of Imperial College and her colleagues wrote in their Annals paper. But the IHME model “rests on the likely incorrect assumption that effects of social distancing policies are the same everywhere.” Because U.S. policies are looser than those elsewhere, largely due to inconsistency between states, U.S. deaths could remain at higher levels longer than they did in China, in particular.

While other epidemiologists disagree on whether IHME’s deaths projections are too high or too low, there is consensus that their volatility has confused policy makers and the public.

See here and here for previous mentions of the IHME. As you may recall, I noted the very wide error bars on its numbers, which tends to be overlooked in the way the stories about this model were written. The IHME is the model that Greg Abbott has used for his reopening plan, so the fact that its projections can change significantly as new data comes in should be of concern. Plus, you know, the whole we are bad at testing thing. However you look at it, the data is noisy, and there’s evidence to suggest there are a lot more people out there with the virus than our level of testing has had the ability to detect. Which is to say again, there’s a lot we just don’t know yet. We shouldn’t rely on one view of the data for our understanding of what is happening, in the same way that we should not rely on any one single poll to understand what is happening in a given election.

Treating COVID-19 patients at nursing homes

This is a huge can of worms.

When Larry Edrozo got a phone call from his mother’s nursing home in Texas City telling him she was being treated for the novel coronavirus with an unproven pharmaceutical drug, he had two questions: why was she getting the drug if she had not been showing symptoms, and who gave consent?

Helen Edrozo, 87, is one of 56 residents at the Resort at Texas City who tested positive for the coronavirus, and one of 39 residents being medicated with hydroxychloroquine, a drug typically used to treat malaria and lupus that has shown some evidence of possibly tamping down symptoms of the virus.

The use of hydroxychloroquine to treat coronavirus patients has drawn controversy globally as the medical community and public debate the ethics of testing a medication before significant research is available — and in the case of elderly patients such as those at The Resort at Texas City, on a population that is statistically more vulnerable to the virus. While President Donald Trump has touted the drug’s benefits, a large controlled study of hydroxychloroquine has not yet been completed, and some doctors warn the drug combination used for the experimental treatment could have severe, potentially deadly side effects.

Larry Edrozo was initially told by an administrator at the nursing home that Helen would not eligible for hydroxychloroquine treatment because she was not showing symptoms. But on Monday, a nurse at the facility phoned him to tell him that his mother’s carbon monoxide levels in her blood had elevated slightly and that she had already begun a hydroxychloroquine dose.

Edrozo was stunned. His mother has dementia, meaning that, as her power of attorney, he is supposed to sign off on any medical treatment she receives at the nursing home.

“I (told the nurse), ‘OK, well, since you’ve already started (treatment), I guess I would write in my notes that the question was raised about consent and what happened to that?’” Edrozo said. “I have not received a call back.”

Dr. Robin Armstrong, the medical director at The Resort, who prescribed the medication shortly after Amneal Pharmaceuticals donated 1 million tablets to the Texas Department of State Health Services pharmacy, said the decision was between him and his patients. He said he did not notify families before the drugs were administered because it was not necessary and time consuming.

“If I had to call all the families for every medicine that I started on a patient, I wouldn’t be treating any patients at all; I would just be talking to families all the time,” Armstrong said

But ethicists say informed consent is one of the most important factors in any treatment, and several people with family members at the Resort at Texas City being treated with hydroxychloroquine say that they were not asked to give consent, despite having power of attorney over their sick relatives.

Still, faced with the desperation of potentially losing his mother to the coronavirus, Edrozo felt he had no other choice than accept this course of treatment.

“When the people are blasting the doctors and the governor’s office about human guinea pigs, I’m sort of there with them,” Edrozo said. “But then I want to ask them, ‘What if it was your mother, or your spouse or your child?’”

As the kids say, there’s a lot to unpack here. At the most basic level, there’s nothing but anecdotal evidence that hydroxychloroquine has any effect on coronavirus. There are no studies worthy of the name showing that it would help. Maybe it will, maybe it won’t, we just don’t know. And that’s without taking into account the inability of these patients on whom the tratment is being tested to give informed consent for their participation. Or the fact that hydroxychloroquine is an actual drug used by people suffering from lupus and malaria, and Donald Trump’s obsession with it as an unproven treatment for COVID-19 means potential shortages for those patients. Did I mention that the doctor leading this effort is a Republican activist who got a supply of the drugs through political connections, and who therefore has a vested interest in making Trump and his hydroxychloroquine predictions look good? All this, and even if it does help some of these patients it won’t tell us anything about the effectiveness of hydroxychloroquine as a treatment because this isn’t a controlled study. Keep in mind, everyone who has recovered from COVID-19 has done so on their own. We’ll have no way of knowing whether the people at The Resort who recover would have done so anyway – that’s why doing controlled studies matter, so you can make valid comparisons. I very much get Larry Edrozo’s dilemma, but he and everyone else involved in this deserved to have full knowledge of the risks and benefits so they could make their own decision.

The digital divide

Online learning is great, if you can get online.

The lack of access to technology among students — commonly referred to as the “digital divide” — has come into sharper focus in recent weeks as school districts across Houston transition to online-based learning amid widespread school shutdowns.

Districts throughout the region are scrambling to equip tens of thousands of children with computers and internet access, jockeying with each other to secure coveted devices in high demand during the pandemic. In the meantime, many districts are providing those students with rudimentary paper materials, asking families to return completed coursework to their schools or take pictures of completed worksheets and send them to teachers.

“This has been on the education docket for, gosh, probably at least 20 years,” said Alice Owen, executive director of the Texas K-12 CTO Council, an association that supports school district chief technology officers. “It’s been a struggle for people to realize that this is an important piece of learning for students if we want to keep them competitive on a global scale.”

Educators and advocates long have warned about the digital divide facing American children, with the nation’s most impoverished children suffering most. The ubiquity and declining cost of computers and internet access has helped shrink the gap, but stark disparities remain.

In the Houston area’s 10 largest school districts, about 9 percent of households — nearly 142,650 — do not have a computer, according to the most recent U.S. Census estimates. Nearly twice that number — about 267,250 households — lack broadband internet access.

Three of the region’s largest and most impoverished districts — Alief, Aldine and Houston ISDs — face the greatest shortages, according to Census data and estimates from district leaders.

[…]

Despite extensive warnings about the digital divide, state and federal legislators have not allocated nearly enough funding to schools to cover costs associated with providing laptops, wireless internet devices and broadband services to all students at home.

Districts can obtain some technology and internet access at steep discounts through a federal program known as E-Rate, but the benefit does not extend to take-home computers or wireless hotspots for students.

“If we want our kids to be competitive and stay up-to-date with tech, we need to be investing in our students for the future,” Owen said. “We’ve got to get over the way school used to be run, and we need to think about the ways that schools are run in the future.”

In a letter sent last week to the top four ranking members of Congress, 35 Democratic senators called for providing $2 billion in E-Rate funds that would allow schools and libraries to deliver wireless internet devices to students without connectivity at home.

“Children without connectivity are at risk of not only being unable to complete their homework during this pandemic, but being unable to continue their overall education,” the senators wrote. “Congress must address this issue by providing financial support specifically dedicated to expanding home Internet access in the next emergency relief package so that no child falls behind in their education.”

Maybe addressing this could be part of Infrastructure Week, or maybe it can be its own item. As the story notes, HISD and some other districts issue laptops to high school students – my daughter has one – which helps with those students, but obviously only goes so far. Charters are not exempt – KIPP reports a similar issue with its students. This is, plain and simple, an issue of poverty. If fixing the underlying issue is too hard, then maybe we can agree that all students need to have the equipment required for an education, and provide them all with laptops and Internet access. The choice is ours – are we going to learn from this crisis, or are we going to face the same problems the next time, without the excuse that we didn’t know any better?