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The great state of Texas

Of course some anti-vaxx groups got PPP funds

Completely on brand.

Texas-based anti-vaccine organization Informed Consent Action Network was among five anti-vaccine groups that collectively received more than $850,000 in federal loans from the Paycheck Protection Program, the Washington Post reported Monday. The organization received $166,000 in May 2020, according to founder Del Bigtree.

“Vaccine hesitancy” or “vaccine skepticism” poses a significant and ongoing challenge for health authorities trying to overcome mistrust within communities of color, by the anti-vaccine crowd and general uncertainty nationwide. Doctors and scientists say the coronavirus vaccines currently available in the United States are safe and effective.

“At a minimum, it’s a mixed message from the government,” said Timothy Callaghan, an assistant professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health. “Those individuals who are hesitant are going to be looking to various pieces of information to help them make this decision…and if one of the key pieces of information coming out is the government funding anti-vaccine groups, it could send a signal to these individuals that maybe they shouldn’t be vaccinating,” he told The Texas Tribune.

The Austin-based nonprofit has more than 43,000 followers on Facebook and regularly posts information questioning the safety of the coronavirus vaccines. Bigtree’s online anti-vaccine talk show was penalized by Facebook and YouTube last year for violating misinformation policies and downplaying the severity of the pandemic.

As the WaPo story notes, this wasn’t just in Texas. In terms of actual dollars, it’s not that much, but boy does the principle of it rankle. And given how Greg Abbott has staked everything on getting the vaccine rolled out, it would be nice if he felt a little heat from this, since the anti-vaxxers have had more success than failure in the Legislature in recent years. You would think he’d be unhappy about this. Good luck getting him to say anything about it, though.

Beware the renewable energy disinformation

It’s out there, in more ways than one.

David Dunagan doesn’t want a 760-acre solar power plant to be built across his fenceline. The Old Jackson Power Plant will replace farmland in Van Zandt County with gleaming, metal panels. Though the 127-megawatt plant will provide clean, renewable energy for some of the nearly 7.5 million residents in the Dallas-Fort Worth metroplex Dunagan has been organizing local landowners to stop it for the last year.

Generations of landowners have raised cattle or grown crops like hay and sweet potatoes in this slice of rural northeast Texas, and turning those fields into an industrial power plant isn’t an easy pill to swallow. One of Dunagan’s major worries is the environmental impact that the Old Jackson plant could have. “It’s literally in the middle of East Texas tornado alley,” he says. “There is a propensity for these facilities to get torn up, and the materials are scattered everywhere. These panels, there are several heavy metals used in thin layers,” he adds. “It’s been proven that these panels tend to leach over time, into the soil and water.”

Thing is, that hasn’t been proven. That’s because it’s not true. According to Wyatt Metzger, a scientist at the U.S. Department of Energy’s National Renewable Energy Laboratory, there’s little truth to the leaching-panel claim. Concerns about what happens if panels are discarded improperly at the end of their 30-year lifespan, are legitimate, however. But the idea that inclement weather could turn a functioning solar farm into a Superfund site littered with lead and cadmium-laced debris has caught on across the country as solar energy developments take off.

It’s a talking point that Dunagan picked up from so-called experts such as Michael Shellenberger, a staunchly pro-nuclear environmentalist who’s called climate activists “alarmists.” It’s been repeated by a national group called Citizens for Responsible Solar, which presents itself as a grassroots coalition, but was formed by a Republican consultant in Virginia. The myth has been pushed by the Foundation for Economic Education and the benign-sounding Institute for Energy Research, both libertarian think tanks that have direct ties to billionaire fossil fuel executives and climate change denialists Charles Koch and David Padden. Koch and Padden fund the Heartland Institute, one of the most infamous climate denial groups.

[…]

Disinformation about renewable energy isn’t new. For decades, fossil fuel companies and conservative think tanks have painted wind turbines as a bird-killing, unreliable, and property-value damaging source of energy. “We’re starting to see the same forces shift over, focusing on solar farms,” says Dave Anderson, a researcher with the Energy and Policy Institute who tracks fossil-fuel-funded disinformation about renewable energy. At the same time, solar energy is on the cusp of a growth spurt: Texas’ solar capacity is on track to grow by 150 percent this year. A similar upward trajectory is expected next year.

Many of the state’s largest solar plants have been built in West Texas, where land is cheap and sun is plentiful. In many of these counties, landowners were already used to having pumpjacks and wind turbines on their sprawling ranches, so solar wasn’t very different. Now, as the price of solar technology has dropped drastically, it’s more feasible for solar companies to locate their plants closer to energy-consuming cities, says Josh Rhodes, a researcher at the University of Texas at Austin’s Energy Institute. In places like Van Zandt, Bell, or Wharton County, just outside of Sugar Land, developers will save on the cost of electric transmission from far West Texas. But here, residents aren’t as welcoming of the new, industrial developments.

This is going to get worse as the Biden administration makes a big push towards renewables as part of its climate change agenda. Be aware of what the propaganda is and be prepared to push back on it when you see or hear it.

More vaccination hubs

Keep ’em coming.

State health officials Saturday announced 79 hub providers that are expected to receive allotments of COVID-19 vaccines this week, including newly designated hubs in some suburbs of Houston.

The hub providers include two in Galveston County, one each in Fort Bend County, Montgomery County and Liberty County and six in Harris County, according to a list of the hubs that are intended to focus on mass vaccination efforts. Officials plan to distribute 333,650 first doses of COVID-19 vaccines to 260 providers across the state. Additionally, the state will order about 500,000 doses expected to be the second ones for people who received their first shot a few weeks ago.

Earlier this month, the Houston region’s three hubs were all in Harris County, making officials in some surrounding counties fear they’d been forgotten. The Texas Department of State Health Services previously said more hubs were likely to be added but that the main obstacle was a short supply of vaccines.

“In the past week, Texas became the first state to administer 1 million doses of vaccine, and vaccine has been administered to residents of all 254 counties,” state health officials said in announcing the allocation breakdown of the week’s doses. “Vaccine remains limited based on the capacity of the manufacturers to produce it, so it will take time for Texas to receive enough vaccine for all the people in the priority populations who want to be vaccinated.”

The vaccine first arrived in Texas on December 14, so that million doses was administered over about five weeks, or less than 30K per day. Things have surely picked up since the first few days, with the emergence of hubs. We’re still working to get to that 50K per day minimum target, which as we have discussed is still a 20-month time frame. Getting the rate higher than that is going to depend on the federal supply, which was very much over-promised and under-delivered by the Trump administration. But today is a new day, and now we have a new President, and things should be looking up soon. Let’s all hope so.

Vaccine roundup

Just a few news stories (and a Twitter thread) of interest from recent days.

How do you get a COVID-19 vaccine? In Texas’ rollout, it’s a game of luck and chance

Still, the contrast shows just how sharp and seemingly random the divide has emerged between those who are able to get the vaccine easily and those who cannot. In the fourth week of Texas’ vaccine rollout, a dermatology practice in Bellaire got 300 doses while Hope Clinic, which serves Houston’s poor and immigrant communities, got 100, according to the state’s most current list.

County registration hotlines have crashed under the volume of applicants while some doctors reported fielding calls from friends asking how to move to the front of the line.

In the month since the vaccines got federal approval, getting them into arms of the most vulnerable has been anything but smooth. Distribution has lagged. Demand has far outstripped supply. Critics call it yet another chapter in the failed government response to a virus that arrived nearly a year ago.

“There does seem to be no discernible distinction between those who are getting the vaccine and those who aren’t,” said Elena Marks, CEO of Houston’s Episcopal Health Foundation, an organization that works to improve health care access for poor.

Such unevenness is happening not just among the public but also within the medical community. At some small and midsize private practices, access to the vaccine remains elusive for front-line health care workers who regularly treat COVID patients, doctors say. Yet employees of large medical practices and big-name facilities are vaccinating staff that is not in direct contact with patients and in some cases working from home.

Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance

Texas has largely left the vaccine rollout process in the hands of local providers like Tarrytown Pharmacy, one of more than 1,000 providers approved to vaccinate Texans. And outside of dictating the first two groups allowed to receive it, providers say the state has given little instruction or information on when allotments will arrive, how immunization operations should be organized and what principles ought to be followed in prioritizing within groups 1A and 1B.

As they spearhead vaccination in a state of 29 million people, hospitals, pharmacies and community health centers alike across Texas built new scheduling systems from scratch, struggled to sync their patient information systems with the state’s and answered to an increasingly anxious public wondering when their turn for the shot will come — all while helping fight the COVID-19 pandemic during its highest peak in Texas.

“Every space I have is booked. I have phones going off the hook saying, ‘Where’s mine?’” said Dr. James McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. “The demand is insatiable right now. Everybody wants it today, and we just don’t have enough vaccines. It will take months.”

The state’s initial allocation of 1.2 million doses had been shipped by Jan. 3, according to state health officials, and another January shipment was expected to bring the state’s total allotment to 1.7 million. That’s still hundreds of thousands of doses short of the roughly 1.9 million necessary to provide just a first dose of vaccine to those Texas health care workers and residents of long-term care facilities eligible in group 1A.

But before many of those first in line had received a dose, the state allowed providers to start administering the vaccine to the second group — about 8 million people older than 65 or at least 16 with certain medical conditions. A Department of State Health Services official said there is some overlap between groups 1A and 1B (doctors and other health care workers over age 65, for example).

The sudden announcement to open vaccinations to the second group — just a week after the first distribution of vaccines for the first group — caught many providers off guard.

“It was in response to all of the chatter and angst to ‘Oh my God, they haven’t given all their vaccines out,’ and it’s been five days,” said McCarthy of Memorial Hermann. “I thought we would get all the health care workers done, and then we would move on. I didn’t think we’d be doing them simultaneously.”

Greg Abbott’s Politics Create a Vaccine Stampede

But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”

In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.

There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.

Advocates worry vaccines will be out of reach for Black and Hispanic neighborhoods devastated by COVID-19

COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.

“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn’t availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I’m very nervous and anxious that this [vaccination effort] is not going to work out for us.”

According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.

And, just as a reminder:

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

New year, same story. We deserve so much better. We’ll get better soon from the federal government. When will we get it from our state government?

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

A parting gift of pollution

Gee, thanks.

Texas may soon get authority over the disposal of ash from coal-fired power plants, a change that could insulate coal companies from tougher rules expected under a Biden administration.

A proposal introduced by the U.S. Environmental Protection Agency this month would allow Texas to regulate coal ash instead of the federal agency. The move comes just after the EPA this year weakened the Obama-era rule on coal ash pollution amid other rollbacks and rule-making maneuvers cementing the Trump administration’s environmental agenda.

Coal ash is a byproduct of burning coal for power generation. The ash is typically dumped into detention ponds or pits and can leach toxic chemicals, such as arsenic, lead and mercury, into groundwater. All of the coal power plants in Texas have coal ash disposal sites that are leaking contaminants, according to data analyzed by the Environmental Integrity project in 2019.

President-elect Joe Biden’s reported pick to head the EPA, Michael Regan, currently leads North Carolina’s environmental agency and has a record of cracking down on coal ash pollution: In North Carolina, he fought to obtain a huge settlement over an 80 million ton coal ash cleanup by Duke Energy — the largest coal ash contamination cleanup in U.S. history.

But if Texas gets authority to implement the coal ash rules before Biden’s new EPA chief has a chance to strengthen the standards, the program could act as a temporary shield for the industry because the state would need to work through a lengthy process to modify already-issued registrations to coal companies.

“It’s always better for industry if the state has control instead of EPA,” said Abel Russ, a senior attorney for the Environmental Integrity Project who helped draft the organization’s comments on Texas’ coal ash program. “States are typically more favorably inclined to what industry wants. That’s true not just in Texas, but across the country.”

Oklahoma and Georgia are the only two states that currently have approval to operate the EPA’s coal ash program. Texas’ program won’t be effective until at least February, when the public comment period ends.

The Texas Mining and Reclamation Association, an industry group that represents coal and other mining industries in the state, supports the proposal, arguing that state-level environmental regulation is more effective.

“This system is designed to give decision-making authority to a level of government that is closer to the people and recognizes that states are in a better position to address specific problems as they arise,” said Michael Nasi, an Austin lawyer, on behalf of the industry group.

[…]

The EPA must review state programs within three years after any change in federal regulations, and the agency has the authority to withdraw approval if the state program is not as protective as federal requirements. The EPA will retain its authority to inspect coal ash facilities. That’s why Nasi, the Texas Mining and Reclamation Association lawyer, said the industry group’s stance is that coal ash standards in Texas will be as protective as federal rules.

The EPA proposed the Texas program for partial approval this month. Because sections of the federal program were being challenged in court by both industry and environmental groups — including a rule allowing unlined coal ash pits to operate, a proposal overruled in court — Texas did not apply to assume all of the EPA’s oversight authority. That means facilities in Texas would have to comply with some federal and some state requirements if the state’s application is approved.

It’s not clear to me what the full implications of this are, if Texas manages to get approval before any further rule changes are made, and it’s not clear to me if any changes can be made before that approval is given. The Congressional Review Act may come into play here as well. My preference would be for Texas to be under much tougher standards, even though as we know from the Obama experience that’s basically a full employment program for lawyers. On the plus side, coal is on the decline in Texas, so whatever kind of fight this turns into will be over a smaller piece of the action. It would still be nice if Texas is subject to the same kind of standards that the rest of the country is.

How’s the vaccine rollout going?

Not very quickly.

Top Texas officials again urged health care providers to administer more coronavirus vaccines Tuesday, the same day the state reported that the proportion of Texans whose coronavirus tests come back positive has hit levels not seen since a summer wave of cases that overwhelmed some hospitals.

The state reported Tuesday that 163,700 Texans had been vaccinated with at least one dose of the vaccine. About 1.2 million doses have been allocated to providers across the state through the first three weeks since their arrival, according to the Department of State Health Services.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Gov. Greg Abbott said in a tweet Tuesday evening.

That tweet came after health officials asked providers that received doses of the COVID-19 vaccine to “immediately vaccinate” all eligible Texans, including people 65 and older and those who are at least 16 with a qualifying medical condition. That renewed push echoed a statement Dr. John Hellerstedt, commissioner of the Texas DSHS, sent to providers last week directing them to “administer their entire allotment with all deliberate speed.”

“Dr. Hellerstedt put out that statement today to make it clear to all providers that people over the age of 65 and people with medical conditions that put them at greater risk of severe disease of death from COVID-19 are eligible to receive vaccine now,” said spokesperson Douglas Loveday. “Vaccine supply remains limited but more vaccine will be delivered to providers each week. It will take time to vaccinate everyone in those priority groups.”

To be fair, lots of states are stuck in low gear right now, but even accounting for that, Texas is in the back of the pack. There are distribution problems, and there is confusion over who can get a vaccine and where and how they can get it.

A single state website and hotline, with accurate and updated information about vaccine locations and supplies sure would be nice. What we have here evokes the old proverb that a person with one watch knows what time it is, and a person with two watches is never sure. Maybe when Greg Abbott and Ken Paxton are finished harassing the city of Austin, they can spend a few minutes thinking about that. In the meantime, hospitals are pushing back against the claim that they are the bottleneck.

The state’s largest hospital association is pushing back against a suggestion from Gov. Greg Abbott and the state’s top health official that a large number of coronavirus vaccines could be going unused in Texas hospitals.

The back and forth comes as the state vaccine dashboard shows that just 205,463 Texans had received the first dose of the coronavirus vaccine as of midweek, although 678,925 doses have been shipped around the state.

Abbott and Dr. John Hellerstedt, the commissioner of the Texas Department of State Health Services, sounded the alarm Tuesday, urging health care providers to begin vaccinating people 65 and over and those with underlying health conditions, including pregnant women, if they have concluded the first phase of vaccinations.

But most hospitals in the state are still vaccinating the first group of eligible Texans — hospital staffers working directly with coronavirus patients; long-term care residents and staff; emergency workers; and home health care workers — or have not yet received any shipments of the vaccine, according to Carrie Williams, spokeswoman for the Texas Hospital Association, which represents more than 85% of the state’s acute-care hospitals and health care systems.

“Vaccine is not sitting on hospital shelves,” Williams said, suggesting the state’s immunization reporting system has caused delays in reporting data. “With regard to data, we have no certainty it is accurate at this point in time. The number of doses administered is higher than what’s indicated.”

While the number of vaccines shipped across Texas is accurate, there have been “varying reports of the actual number of vaccines administered,” a spokesman for the Texas Division of Emergency Management said Wednesday.

The agency launched a website Wednesday showing up-to-date numbers of vaccine doses and therapeutics available at health care providers.

Abbott spokeswoman Renae Eze touted the website as a source of “real-time reporting system to show vaccine usage data from health care providers across Texas.”

The site, however, does not show how many COVID-19 vaccine doses have been administered.

[…]

For their part, hospital directors say the call from state leaders to move onto the next tier of vaccinations has caused chaos across the state as hospitals try to manage a vaccine rollout and a growing number of COVID-19 patients, Williams said.

“Hospitals are being flooded with calls from the general public seeking vaccine, which creates further operational challenges,” she said. “And, there are still hospitals that have not received any vaccine for their frontlines.”

The story doesn’t indicate what the URL of this new website is. The TDEM website is here, but all I found on a cursory search was information about testing, not about vaccines. This WFAA story about the bumpy vaccine rollout says that this DSHS page is the state’s main vaccine information center, but it’s mostly about eligibility. The story also reports, as Miya Shay did in her tweet, that DSHS and TDEM have two different maps showing providers who have received vaccine doses, and advise people to reach out to providers with their questions. That is not going to help with the flood of questions hospitals are already getting. Meanwhile, State Rep. Donna Howard tried to answer some questions on Twitter:

You can read the thread, but it largely comes down to lags in reporting, the timing of distribution, and confusion over who is eligible. For a guy who’s emphatically rejected calls for further COVID restrictions because the vaccines will save us all, you’d think Greg Abbott would want to put more effort into getting the vaccine distribution part of it right. Just a thought, but maybe this should be a campaign issue next year. What has been your experience trying to chase down a vaccine, for yourself or for a family member?

UPDATE: Later last night, the Trib published this longer story that covers all of the topics I’ve touched on here and more. At some point, Greg Abbott really needs to feel some heat for this.

A new high in hospitalizations

This is fine.

The Texas Department of State Health Services reported Monday a pandemic high 11,351 hospitalizations from COVID-19.

This surpasses the previous all-time high of 10,893, which occurred on July 22.

The record comes in the midst of a holiday season public health experts worry could exacerbate the already rapidly spreading virus and following an increase in cases weeks after Thanksgiving.

This hospital data does not account for people who are hospitalized but have not gotten a positive test, and DSHS says some hospitals may be missing from the daily counts. As of Monday, the state is also reporting 49 deaths from COVID-19, a lagging indicator of the extent of transmission rates, and more than 12,800 new confirmed COVID-19 cases. Reported cases may have appeared lower the last few days because some local health departments did not report data to the state over the holiday week.

Earlier this month, Texas’ ICU capacity was already the lowest since the start of the pandemic, leaving health care experts worried hospitals could be pushed to the brink as coronavirus cases continue to climb. Across the state, COVID-19 patients occupy 17.8% of the state’s hospital beds, and only 745 staffed ICU beds are still available.

At a press conference Monday, Mark Escott, Austin’s interim medical director and health authority, said that this week alone, “ICU utilization” is up 62% in Travis County and that hospital beds could become scarce in a matter of weeks.

“Our projections forward into the new year continue to look worse and worse day after day,” Escott said. “I think right now it appears we’re going to enter 2021 in a state of emergency.”

This is fine:

This is fine:

Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, said he anticipated a major fall surge amid a wave of new infections in West Texas and the Panhandle.

Those areas are among the hardest hit in the country, he said.

“Up in Midland and places like that, it’s still a really tough area,” he said, adding, “In terms of surges, I’m maybe a little less worried about the Texas Medical Center. But in other parts of the state, it’s going to be a real concern.”

There are 745 ICU beds available across the state, according to data from the Department of State Health Services, the lowest number available since the pandemic’s surge during the summer. Among 63,679 staffed hospital beds, 13,416 are available statewide.

Further, 15 of the state’s Trauma Service Areas are reporting that more than 15 percent of their total hospital capacity is taken up by COVID-19 patients, crossing the threshold for what the state considers “high hospitalizations.”

At the Texas Medical Center, the weekly average of new COVID patients has more than doubled since early November, from 104 to 248. Medical center data from Sunday shows 1,594 total COVID patients and another 404 in the ICU. There are 1,298 total occupied ICU beds with hundreds more available, the data shows.

“The medical center has gotten a lot of heft, in terms of being able to accommodate COVID patients,” Hotez said.

[…]

The sporadic use of masks has contributed to the surge, said Hotez, adding that he doesn’t anticipate the number of statewide hospitalizations decreasing anytime soon. He noted that the number of beds is less of a concern than the number of trained staff available.

Hotez said he did not know how much Christmas gatherings would impact the number of infections. But he warned people that New Year’s celebrations would be the “best party the COVID virus can hope to have.”

“I would just say any kind of New Year’s celebration is fraught with risk ,” he said. “Because when you have this high level of transmission going on in the state, anytime you bring four or five people together, there’s a good likelihood they’re going to have COVID.”

I’m really scared for what the next few weeks may bring. Wear your mask, practice social distancing, avoid indoor gatherings, and try to survive until you can get vaccinated.

Hunting hogs from hot air balloons

Not as popular as hoped.

Turns out, hunting feral hogs from a hot air balloon is not all that popular in Texas.

Three years after state lawmakers approved the high-flying hunts, no balloon company has gotten a permit, according to Texas Parks and Wildlife.

Gunning down feral hogs from a helicopter, however, has taken off. Since the Legislature passed the so-called “pork chopper” bill in 2011 to drive down invasive pig populations, scores of businesses have begun offering aerial hog hunts to customers willing to pay thousands of dollars for the experience.

[…]

[Ag Commissioner Sid] >Miller said he floated the hot air balloon proposal to a state lawmaker after meeting a West Texan who raved about using balloons to hunt hogs. They are less noisy than helicopters and offer a more steady shooting platform, proponents have said.

Still, balloons come with their own challenges, chief among them, the wind, which can send hunters flying in the opposite direction of the hogs.

“Even though you might know where the winds are forecasted to go, doesn’t mean that’s always what the winds are going to do,” said Josh Sneed, Southwest Region Director for the Balloon Federation of America.

Sneed doesn’t know any Texas balloon pilots who offer hog hunts. Safety has been a chief concern, he said.

“You can do it safely,” he said. “But most pilots don’t feel comfortable having people carrying rifles in their balloons with them and discharging (them).”

Helicopters have proven far more popular. There are currently 155 active permits for aerial wildlife management that list helicopters, according to Texas Parks and Wildlife.

HeliBacon, based in Bryan, has approval from farmers and ranchers to hunt hogs across roughly 300,000 acres in the area, said CEO Chris Britt. Hogs tend to be nocturnal, so the after-dawn excursions last just a few hours. About 85% of the company’s customers come from out of state and some of them from abroad, he said.

“From the customer’s perspective, they want to fly in a helicopter at a low level. They want to shoot a machine gun. They’re chasing a live, moving target,” Britt said. “The fact it happens to be a feral pig that they are killing… and it’s good for the ecology, the farmers and the economy is a bonus.”

Using aircraft to take out an entire group of wild pigs is effective, but if some get away, they learn to start avoiding the sound of helicopters, said John M. Tomecek, Assistant Professor and Extension Wildlife Specialist at Texas A&M University.

See here, here, and here for more on the pork-chopping bill, which also got off to a slow start. I don’t know how I missed the story of the hot air balloon option, but it wasn’t expected to do much anyway.

It’s easy to make fun of all this, and honestly I don’t know why anyone would want to pilot any kind of aerial vehicle while one or more people in said vehicle was firing guns at moving targets, but as we have noted many times before, feral hogs are a huge problem in Texas. It’s nearly impossible to control the population growth, because they reproduce so quickly and plentifully. I’m fine with some outside-the-box ideas to try and keep the population under some control – a plan to deploy poison against the hogs was ultimately withdrawn after concerns were raised about environmental damage – though as the story notes, it’s not clear how effective the pork-chopping strategy has been. But hey, until something better comes along, at least people are trying it.

Too much virus, not enough treatment

Still a bad combination.

Three weeks after Gov. Greg Abbott visited Lubbock to celebrate new antibody treatments amid a surge of infections, the city remains in crisis. Its two main hospitals had nearly two dozen patients waiting for beds Friday, and the city has administered only about 200 doses of the new medications, with about 4,500 active cases countywide.

Hospitals are also filling in Dallas, Houston, San Antonio and other parts of the state that were slower to be hit by the fall surge. The state is hovering around 9,000 hospitalized COVID-19 patients and reported fewer than 700 available intensive care beds for the first time this week, less than half the supply in September.

While most hospital officials in Texas welcomed the new treatments and remain hopeful that they prevent some hospitalizations, the limitations are also becoming apparent. Without enough doses or a way to distribute them quickly, hospitals will continue to be strained unless infections slow or until vaccines become widely available, not likely until at least early summer.

In Lubbock, hundreds of nurses and other hospital employees are out sick or quarantining from the coronavirus, and administrators worry that the hundreds more who have come to help from across the state and country will be called back as outbreaks in their home communities worsen. More than 231,000 new cases were reported Friday nationwide, nearly 4,000 above the previous record set on Dec. 4.

“We always have more contingency plans, and we’re deep into the middle of some of those where we truly are turning away patients from outlying communities because we can’t take them,” said Dr. Ron Cook, Lubbock’s health authority and the chief health officer at the Texas Tech University Health Science Center.

The treatments, made by the companies Eli Lilly and Regeneron, were granted emergency use authorizations last month to help prevent hospitalizations for the most vulnerable patients, including those over 65 and with chronic illnesses such as diabetes, obesity or kidney disease. They are the same treatments President Donald Trump and his lawyer Rudy Guiliani have received.

Texas got about 20,000 doses in the past five weeks, while it reported 330,000 new infections. Early clinical research suggests the drugs prevent about 1 in 20 people who receive them from being hospitalized.

Doctors at University Medical Center in Lubbock are encouraged by the early outcomes, but have often struggled to contact and persuade enough eligible patients to receive the treatments. The drugs need to be administered early on, before a person is hospitalized, and patients may not yet have developed symptoms. Some have never heard of the treatments or spoken with the hospital’s doctors before.

[…]

Combating the virus has been especially tough in Lubbock, a college town in a fiercely independent swath of the state where pandemic science has been regularly questioned and the governor’s tepid mask mandate largely unenforced. In recent weeks, the mayor and others have resorted to pleading with residents to physically distance and wear face coverings.

“Our independence is also hurting us,” Cook said.

Abbott’s mask order includes several exceptions and calls for fines only on the second offense, which county officials have said is nearly impossible to track.

It’s like I was saying. Prevention will have an exponentially better effect on the pandemic than treatment will, and that’s true even if the treatment we’d been given was much more effective than preventing five percent of its recipients from being hospitalized if they take it in time. Donald Trump and Greg Abbott have failed us at so many levels.

(This story is from two weeks ago, it’s been in my drafts because there’s been so much news as well as the holidays. It’s possible things are a little better in Lubbock now – I sure hope they are – but the point still stands. We are reacting instead of trying to take control of the situation. We’ve been doing that for months. The fact that we have better tools now to react with doesn’t change that.)

Next in line for the vaccine

Attention will shift to more vulnerable populations.

Texans who are 65 years old and older, and those who are at least 16 with certain chronic medical conditions will be next in line for the COVID-19 vaccine, the Texas Department of State Health Services announced Monday.

“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” said Imelda Garcia, chair of the state Expert Vaccine Allocation Panel and DSHS associate commissioner for laboratory and infectious diseases. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”

The vaccine, which arrived in Texas on Dec. 14, has been available so far only to front-line health care workers and residents of long-term care facilities. There are nearly 1.9 million Texans in that group, so it will likely take a few weeks before the state transitions to the next phase, state health officials said.

The state expects to receive 1.4 million vaccine doses by the end of the month. Eligible facilities under the current phase include hospitals, pharmacies, nursing homes and Texas Department of Criminal Justices facilities.

The city of Houston will also receive 6,000 doses that are ticketed for firefighters and health care workers, so that’s good. A list of comorbidities that would get you onto the eligible list for the vaccine is in the article, so click over and check it out if you think this may apply to you or someone you know. But do keep in mind that bit about it taking a few weeks to transition into that next phase, because it will take awhile to get through the first phase. We need to continue to practice prevention so as not to sicken and kill many more people needlessly.

Indeed, for those of us in Houston, the next few weeks are looking rough.

The spread of COVID-19, steadily increasing in Houston and Texas since the beginning of November, is expected to accelerate in coming weeks, according to the latest modeling, a trajectory that could make the city and state one of the nation’s next hot spots.

The models project COVID-19 numbers — cases, hospitalizations, deaths — to continue rising in Houston and many other parts of Texas before likely peaking sometime in January. Parts of the state at crisis levels the past month have peaked.

“There’s a lot of concern about the Houston area as we enter the Christmas season,” said David Rubin, a pediatrician and director of The Children’s Hospital of Philadelphia’s PolicyLab, which produces one of the models. “If I were to say what areas in the country still have the potential to surge, the Houston area definitely would be one of them.”

Rubin and others urged everyone to hunker down over the coming holiday period in an attempt to limit the damage from the coronavirus’ seeming last onslought before gradually deployed vaccines can begin to shut down the pandemic. He noted widespread deployment won’t be in time to affect Houston’s winter peak.

[…]

“What’s concerning is that so many regions of Texas look to be hit about the same time,” said Spencer Fox, associate director of the UT COVID-19 Modeling Consortium. “It’s a sad trend at a time when the vaccines are almost within reach.”

The Houston-area trends are worrisome in two of the models. Fox’s group projects 2,121 COVID-19 hospitalizations in the area on Jan. 15, for instance, an increase of 36 percent over the 1,561 such admissions for Dec. 17.

In addition, the CHOP PolicyLab modeling shows the number of Harris County COVID-19 cases should nearly double by the end of the first week of January. The model projects 2,919 cases on Jan. 7, up from 1,478 on Dec. 14.

A third forecast, by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), projects the number of deaths in Texas will peak Jan. 5 at 292. The model, the only one of the three that projects more than a few weeks out, says daily deaths would total 280 on that date assuming universal mask wearing but reach 345 by late January if mandates are eased.

Thanks partly to the vaccines, the IHME model projects the number of daily Texas deaths will decrease dramatically after the Jan. 5 peak — 138 on Feb. 1, 55 on March 1 and 17 on April 1. The vaccine’s most immediate effect is expected to be more of reducing severe illness and deaths than cases.

The IHME model does not project past April.

In all, 28,134 COVID-19 Texas deaths are expected as of Dec. 31, according to the IHME model. All but 2,700 of those came after June 30.

“That’s a devastating loss of lives in just a six-month period,” said Dr. Peter Hotez, a Baylor College of Medicine infectious disease specialist and vaccine scientist. “Has Texas ever lost so many lives in such a short time?”

The CHOP PolicyLab foresaw the June/July spike, though they were more alarmist than the situation turned out to be. But between the holidays and the colder weather that makes outdoor dining less feasible, the conditions are certainly there for an uptick. We all know what to do about this, it’s just on us to actually do it.

We still need more than the vaccines

The vaccines are great, don’t get me wrong, and they couldn’t have come at a better time, but they’re going to take awhile to be administered, and in the meantime a whole lot of people are still getting sick and dying.

Gov. Greg Abbott on Thursday applauded the arrival of the new coronavirus vaccine, calling it a “monumental medical miracle” as he sought to boost morale amid some of the pandemic’s toughest days.

Speaking outside a UPS distribution center in Austin, the governor painted an especially rosy picture of the weeks ahead, promising a swift vaccine rollout even as national supplies are limited and the state is reporting high numbers of new daily infections. Hospitals in some cities across Texas have been overrun with COVID-19 patients.

The vaccine, which began rolling out on Monday, “is on a daily basis saving lives and beginning to restore normalcy in our community,” Abbott said.

About 90,000 doses have been distributed in Texas already, and another 150,000 were being shipped out on Thursday. The first batch is intended for health care workers treating COVID-19 patients.

State health officials are still determining whom to prioritize from there, including teachers, public safety employees and prisoners. The governor himself has yet to be inoculated but said he plans to at “the appropriate time.”

Texas expects to receive 1.4 million doses by the end of the year, not quite enough to treat all of the 1.6 million health care workers who would be eligible.

[…]

State and national health experts have cautioned that it will be well into 2021 before vaccines become widely available and that infections will continue to spread as long as some resist safety measures such as physically distancing and masking in public.

“It’ll still be weeks, perhaps months, before it is absolutely available to anyone who chooses to have it,” said John Hellerstedt, commissioner of the Texas Department of State Health Services. “In the meantime we need to continue the kinds of things that have gotten us this successful so far.”

Abbott has so far refused to tighten the state’s mask mandate or impose other new restrictions, even as county officials have asked for them as they battle new waves of infections. On Monday the state reported nearly 18,000 new confirmed and probable cases, as well as 252 deaths. More than 24,000 Texans have died from COVID since March.

For a very sobering look at where we’re headed, read this:

What is the one thing that could mitigate this? Another lockdown, with a mask mandate alongside it. What is the one thing that could mitigate the devastating economic effect of another lockdown? A truly adequate COVID stimulus package from Congress. What are the two things Greg Abbott is never going to do? You get the picture.

There’s also this.

The start of COVID-19 vaccinations for health care workers has sparked hope that the end of the pandemic crisis is within sight, but when it comes to vaccine distribution, this is still the easy part. Local and state health agencies say they will struggle to get hundreds of millions of doses of the vaccines to the general public without a huge amount of additional funding. Even if Congress does manage to pass a compromise relief bill, the amount it provides may not be enough.

The fates of the vaccine and the relief bill, both months in the making, are linked. The $900 billion proposal that Democrats and Republicans on Capitol Hill continue to debate has a number of provisions to mitigate the COVID economic crisis, including additional unemployment benefits and small business support. The latest available version also contains $6 billion in vaccine distribution funding for state and local health departments. But groups that represent state and local health departments say that this funding, while crucial, won’t be sufficient to distribute the vaccine on a massive scale as efficiently and widely as possible.

“We see the $6 billion that’s on the table as an important down payment to scale up staffing, develop and enact communications plans to address vaccine hesitant populations, and enroll more vaccinators,” Jasmine Berry, the communications director at the Association for Immunization Managers, says in an email. “There’s still going to be a need for additional funding for state and local health agencies.”

What’s more, the already months-long delay in getting this funding to state and local health departments may create problems down the line, as the country’s vaccination campaigns expand beyond health care workers and nursing homes.

“Where we’ll really start to see potential delays, or where we are not as successful as we could have been, may be as we move through the phases to the next group, where there’s a much larger population that would need to be served,” says Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials, which represents local health departments.

How much of the vaccination tab are Greg Abbott and the Legislature willing to pick up if Mitch McConnell continues to block any COVID relief bills from passing? A miracle’s no good if you can’t access it.

Abbott is right that the vaccines will save lives and restore normality to our lives. But only if we live long enough to get vaccinated, and only if the funding is there to make sure everyone can get vaccinated. These things aren’t going to happen by themselves.

Can we get enough people vaccinated?

It’s going to take a lot of work.

In poll after poll, alarming numbers say they don’t plan to be inoculated with the vaccine, whose 95 percent efficacy rate in trials exceeded everyone’s expectations. It’s scientists’ nightmare: create one of medicine’s landmark achievements only to have large numbers of people not bother to get it.

But that appears to be the reality. Although the numbers appear to have improved since drugmakers Pfizer and Moderna reported their impressive trial results last month, about 40 percent of Americans tell poll takers they don’t plan to get a COVID-19 vaccine. In Texas, only 42 percent say they will.

Public health officials fear such numbers will hinder the campaign to shut down the greatest scourge since the 1918 Spanish influenza.

At stake is a possible squandering of the chance to get COVID-19 under control by late summer, to save countless lives that will be lost the longer it takes to stop the spread of the virus. Also at stake is an increased potential for a more lethal or contagious strain of the virus to emerge, always a threat as long as an infection continues to circulate.

“The hesitancy is bad for getting the population vaccinated to obtain herd or community immunity, which would allow for activities to become normal again,” said Kirstin Matthews, a fellow in science and technology policy at Rice University’s Baker Institute. “The Biden administration will need to find ways to gain public trust in the Centers for Disease Control and Prevention and FDA to ensure communities take the vaccine.”

A national task force led by Johns Hopkins Center for Health Security and Texas State University’s anthropology department added that “if poorly designed and executed, a COVID-19 vaccine campaign in the U.S. could undermine the increasingly tenuous belief in vaccines and public health authorities who recommend them, especially among people most at risk of COVID-19 impacts.”

[…]

Vaccine mistrust has been building for years, fueled by a small but growing movement that works to exempt children for “reasons of conscience” from school-required inoculations. But the COVID-19 vaccine has brought a new audience to such groups, like Texans for Vaccine Choice. Its leader told publications this summer that its phones were ringing off the hook with calls from people who said they’d gotten other vaccines but don’t want this one.

Neil Johnson, a physicist at George Washington University who studies anti-vaccine groups on social media, has estimated that in recent months, 10 percent of people on Facebook asking questions about vaccines have switched to anti-vaccine views.

“It’s going to be a bumpy road,” said Peter Hotez, a vaccine scientist at Baylor College of Medicine. “Given media scrutiny and an aggressive anti-vaxxer movement, particularly in Texas, any adverse vaccine events are going to be amplified.”

The story cites this Texas Tribune poll from October. I feel like things are probably a bit better now, mostly because it’s clear we will now have a competent administration that takes the pandemic seriously in charge of getting the vaccine out. For sure, messaging is going to be key to this, and all of us will need to play a part to make sure our family and friends have good information and make good choices. This Twitter thread has some good advice.

There will no doubt be significant resistance no matter what, and we may have to reach a point where we impose sanctions on people who could get the vaccine but haven’t. I don’t know what that might look like, and honestly I’m not sure if there’s a practical way to do what I’m suggesting. It’s way premature at this point anyway, but it’s best to be prepared for all possibilities. And as much as anything, we need to be prepared to fight off any effort in the Lege to coddle the anti-vaxxers, who already have had way too much influence, and success. If we can just avoid not making things worse, that will be a big win.

UPDATE: See this NPR story for evidence of growing confidence in the COVID vaccine.

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 regional COVID situation

Not great, Bob.

COVID-19 is surging across southeast Texas, especially in the suburban counties outside of Houston, which have seen a steady increase in the number of new cases, data show. Galveston, Chambers, Brazoria, Liberty, and Montgomery counties have all had higher COVID-19 cases per capita than at any point during the pandemic. Chambers County leads the region with 463 virus cases per 10,000 residents, followed by Galveston County with 433 cases per capita, according to data compiled by the Houston Chronicle.

Experts say the latest spike is driven by a combination of factors — public fatigue from basic COVID-19 restrictions such as mask wearing and social distancing, but also more family gatherings in households and larger groups in bars and restaurants. While case counts are consistently much higher than they were in previous weeks and months, they have yet to equal the peak seen during the summer.

Yet the virus’s resurgence in places like Galveston County has put business owners like Railean on edge, owing to an executive order from Gov. Greg Abbott that could trigger new restrictions — including the complete closure of some bars — if regional virus hospitalizations exceed 15 percent of hospitals’ total bed capacity for seven consecutive days. At a time when thousands of restaurants — as many as 10,000 across the state, per the Texas Restaurant Association — have closed due to the COVID-19 pandemic, further closures could be catastrophic for the industry.

“It would be absolutely devastating to lose this holiday season, devastating to our businesses,” said Gina Spagnola, president of the Galveston Chamber of Commerce.

The Texas Department of State Health Services divides each of the state’s 254 counties into 22 “trauma service areas” which coordinate systems of emergency healthcare and preparedness for their respective regions. Galveston, Chambers, Brazoria, and Liberty Counties are part of a nine-county region trauma service area where COVID-19 hospitalizations have spiked significantly since early November. On Saturday, the region’s rate of hospital beds in use by covid-infected patients eclipsed the 15 percent mark for the first time before dipping back down to 13 percent by Tuesday.

After seven consecutive days above that 15 percent mark, per Abbott’s executive order, the state health agency would notify county judges in all nine counties of the following restrictions: hospitals must suspend elective surgeries; businesses including restaurants, retail stores, offices gyms, and museums would be limited to 50 percent capacity; and bars and other establishments with more than 51 percent alcohol sales must close.

I wish the Chron had included the comparable number for Harris County. I tried computing it myself based on the Chron’s coronavirus page and 2019 Census numbers I found on Wikipedia, but I got higher totals for Chambers and Galveston than what the story gives. The Harris County number I calculate by the same method was lower than those two, but I don’t know how to adjust them, so we’ll leave it at that. I could still probably make a moral comparison between Harris’s more strenuous effort to combat the virus and the more lax attitude of some neighbors, but I don’t know what that would accomplish at this point. The bulk of the blame for all this remains with Donald Trump, Greg Abbott, and the Senate for not passing further COVID relief, which among other things might have helped all these businesses to survive without being open. We can’t wind the clock back and make Trump take COVID seriously, but we could still do the stimulus. Greg Abbott could still tell our Senators to demand that the Senate pass something that would help our state and our businesses. I’m going to keep saying that, every time. On so many levels, it didn’t have to be like this.

The bar conundrum

Ugh.

Halloween this year in downtown Austin was a raucous affair. Nightclubs advertised dancing and drink specials. Thousands of people crowded 6th Street, partying shoulder to shoulder, some with masks and some without.

All of this happened as bars in Austin were still under a shutdown order to stop the spread of the coronavirus.

Those bars and nightclubs are some of the more than 2,500 so far that have been permitted to reopen by the state on the promise that in the middle of a pandemic, they’d convert themselves into restaurants.

Shuttering Texas’ nearly 8,000 bars has been one of Gov. Greg Abbott’s most drastic safety restrictions. He most recently allowed bars to open in parts of the state where coronavirus hospitalizations are relatively low, with permission from the local officials.

But in areas where bar bans are still being enforced, many of those businesses are still operating like, well, bars. Just weeks after Halloween, with Thanksgiving on the horizon, frustrated health experts and local officials say the loophole is defeating the purpose of the bar ban and could be one reason the state is battling its largest outbreak in months.

“The restrictions were put in place for a reason,” said Dr. Philip Huang, the director of Dallas Public Health. “And if you get around it, if you’re trying to cheat, then you’re sort of eliminating the reduced transmission that you’re trying to achieve.”

Public health officials and experts have said since this spring that bars pose unique dangers for spreading COVID-19. The Texas Medical Association notes it is one of the worst ways to spread the virus.

“Packed bars, where people are talking very close to each other and they’re shouting, or they’re yelling and people are touching a lot — that’s super high risk,” said Aliza Norwood, a medical expert at the Dell Medical School at the University of Texas at Austin.

If the current trend continues — over 8,300 Texans were hospitalized with confirmed coronavirus infections Monday, up by nearly 900 from last week — “there may be a time in which it is appropriate to shut down bars and restaurants completely,” Norwood said.

Austin health officials agree.

“We are at a precarious spot right now where cases are rising across the country,  cases are rising across Texas,” said Mark Escott, interim Austin-Travis County health authority, before adding, “We really have to find a way to stabilize things to avoid that surge.”

But Abbott, who has concentrated power within himself to take action on COVID-19, said he has no plans to do so. He did not respond to requests for comment.

I’ve been an advocate for taking steps to help bars survive, with the rule interpretation that lets them be classified as restaurants a key component of that. I’ve done this because I want to see these businesses survive and their employees keep their jobs, and I believed it could be done in a reasonably safe fashion, with an emphasis on outdoor and to-go service. That obviously hasn’t worked out so well. The best answer would have been to pay the bars to shut down long enough to get the virus under control. It’s still not too late to do that, but that’s going to require Mitch McConnell’s Senate to take action, and I think we both know that’s not going to happen. One can only wonder what some advocacy from Republicans like Greg Abbott and Ted Cruz and John Cornyn might have accomplished, but that would have required them to take this seriously in the first place. In the meantime, just because these places are open doesn’t mean you have to go to them, or that you have to be inside of them if you still want to support them in some way. Keep yourself safe, at least.

What happens when there’s no room for the sick people?

It’s already happening in some parts of Texas, mostly out west.

Sarah Vasquez for the Texas Tribune

Presidio and Brewster counties, home to Marfa and Big Bend, along with nearby Culberson County, lead the state in cases per 1,000 residents in the last two weeks, according to a Texas Tribune analysis. In fact, all of West Texas, including Jeff Davis, Hudspeth and El Paso counties, is ablaze with increasing COVID-19 cases and low on hospital beds.

Big Bend Regional Medical Center, the only hospital in Presidio, has just 25 acute care beds. Culberson County’s 2,200 residents have just Culberson Hospital, where there are 14 beds and two ventilators, but at least one doctor said she doesn’t feel adequately prepared to use them.

Patients in dire condition are often transferred from the small towns to regional hospitals in larger metropolitan areas. But those closest hospital systems in El PasoLubbock and Midland, which have more resources, are already struggling with their own influxes of local cases, leaving doctors and county officials worried a bump in cases from Thanksgiving gatherings will fill beds beyond capacity with nowhere left to send the sickest patients.

“It’s unlikely we’d be able to help them at this point,” said Ricardo Samaniego, the county judge of El Paso, where COVID-19 patients occupy more than 35% of hospital beds.

Without El Paso as an option to send patients, nearby doctors and officials are scrambling.

“It’s a scary feeling to have a critically ill patient with nowhere to go,” said Gilda Morales, a Culberson County commissioner and doctor at Culberson Hospital.

She said that in recent weeks, the county has sent struggling patients to hospitals in San Antonio — more than 400 miles away — including Culberson County Judge Carlos Urias, who’s been there for nearly four weeks.

If a flood of residents need to be hospitalized quickly, and cases in San Antonio and other metropolitan areas swell, Culberson might not have the resources to treat everyone in need, Morales said.

“We’re worried those beds will run out, and then what?” Morales said. “We’re all holding our breath because as much as we told people not to get together for Thanksgiving, the holidays and family give a false sense of security.”

Hospitals across the West Texas region are “bumping capacity and stretched absolutely to the limit,” said John Henderson, president of the Texas Organization of Rural and Community Hospitals. Administrators have struggled to find open beds, in some cases calling 15 or 20 facilities, he said.

“Everyone is headed the wrong direction,” he said. “Every week is a little worse than the last one.”

In Odessa and in neighboring Midland, the area’s three hospitals serve as “referral centers,” accepting patients from small-town facilities that are ill equipped to treat serious illnesses.

“All of our outlying facilities, they don’t have ICUs or ventilators that can take care of patients long term,” said Dr. Rohith Saravanan, chief medical officer of Odessa Regional Medical Center. The hospital in recent weeks added 34 beds for people with COVID-19, and, as of Tuesday, only four were still empty.

“If we see any more sharp rises, I don’t think our hospitals will be able to keep up with capacity,” Saravanan said.

Scenic Mountain Medical Center in Big Spring is one of those outlying community hospitals. The facility’s seven intensive care unit beds are full, as are 18 overflow beds that fill the hallways.

Just as a reminder, people still have heart attacks and get in car crashes and fall down stairs and get shot. They’re competing for increasingly scarce hospital resources with all of the COVID patients, too. I don’t have any answers for this, or at least I don’t have any answers beyond what I and many others have been saying for months – wear your face mask, avoid indoor gatherings, observe social distancing. More to the point, Greg Abbott doesn’t have any answers, either. That’s a lot more consequential.

Even the White House thinks Texas sucks at COVID response

I mean

The White House Coronavirus Task Force says Texas is in the swing of a “full resurgence” of COVID-19 and the state’s mitigation efforts “must intensify,” while Gov. Greg Abbott and other leaders decline to take some of the steps the Trump administration is recommending.

A report issued by the task force before the Thanksgiving holiday calls for Texas to significantly reduce maximum occupancy for public and private indoor spaces and to conduct weekly coronavirus testing of teachers, college students, county workers, hospital personnel and others.

“Texas continues to be in a full resurgence and mitigation efforts must intensify,” the Nov. 22 report says. “The silent community spread that precedes and continues to drive these surges can only be identified and interrupted through proactive, focused testing.”

The White House sends such reports to states weekly, but they are not typically made available to the public. The report was published by the Center for Public Integrity.

Three days before the report was issued, Abbott was assuring the public that local officials had been provided with all the tools they need to slow outbreaks, including a requirement that Texans wear masks indoors in public places and when patronizing businesses.

Abbott has also enacted mandatory occupancy reductions — including closing bars — in regions where the number of hospitalized COVID-19 patients exceeds 15 percent of capacity for seven straight days.

But Abbott has declined to go further, instead focusing his message on treatment, touting a newly approved drug as proof that “the cavalry is coming.”

There are plenty of local officials who would disagree with Abbott’s assertion that they have all the tools they need.

Mayor Sylvester Turner on Tuesday said he agreed with the White House report’s findings and implored Abbott to take a harder line or give local officials back the powers they had in the spring.

“We determined what the occupancy limits were going to be in large part. We had the ability to say ‘no,’” said Turner, who took questions from reporters after a holiday-themed event at City Hall. “The tools that we had in March and April, we no longer have. We are not driving this car. County judges and mayors are more like passengers. The state is driving the car.”

In addition to Abbott’s May preemption of local restrictions, bars that collect less than 51 percent of their revenue from alcohol also can reopen as restaurants, and the Texas Alcoholic Beverage Commission in August made that easier by broadening the scope of revenue they can count as not stemming from alcohol sales.

“Bars can be open. So, we’re doing what we can to limit gatherings, but that’s a big, big problem,” Harris County Judge Lina Hidalgo said during Tuesday’s regularly scheduled meeting of Commissioners Court. “Because these things have been allowed, we’re seeing the numbers we’re seeing again now.”

Measures of the virus’ spread, Hidalgo noted, approximate the levels being reported when she placed the county at its worst, “red” threat level in June.

“It was soon after that that the governor pulled back a little bit, and the numbers kept climbing until finally they peaked at a level where they routinely exceeded base hospital capacity” in intensive care units, she said. “And so if we go much longer without action, we’re going to be in a bad place.”

One option the city does have is a curfew, which has been implemented in El Paso and San Antonio. Turner said he reserves the right to implement one in Houston, but views that as a “nuclear option” that punishes good actors along with the bad.

The mayor said he is trying to keep people alive for the next few months, until vaccines become available and strengthen the fight to contain the virus’ spread.

“My appeal to the governor is to join with us and do the same,” he said.

Remember how they once had to solve the riddle of the Sphinx to unlock some of those tools in the first place? Boy, those were the days. The Chron story notes that while the local numbers aren’t as bad as they were in July, they are all on an upward trend. That ain’t good.

What could be done? In addition to letting the locals actually do the things they want to do, Abbott could issue a new mask mandate, with enforceable penalties attached, and take the heat from the wingnuts for it. He could order more enforcement of bar and restaurant occupancy limits, to crack down on the bad actors. It also remains true that Abbott could be exhorting our two Republican Senators to get off their asses and support a big COVID relief bill that would get affected businesses through the next few weeks. Even this wholly inadequate effort would be better than nothing. “Doing nothing while we wait for the vaccine and try out new treatments for the many people who get sick” and “completely shutting down everything with no financial relief for anyone” aren’t the only options available. The Trib has more.

More on DPS and data protection

A followup from the DMN about that data breach involving every drivers license number you’ve ever had.

Some other states do not sell [drivers’ license] data, but Texas does. State lawmakers could change the law in their 2021 session.

I first reported this in 2015 when I learned that several state government departments sell information to outsiders. In an open records request that year, I learned that in 2014 the Department of Motor Vehicles earned $2.4 million in sales.

This year, CBS 11/KTVT reporter Brian New updated those numbers. DMV made more than $3 million in 2019 selling drivers’ names, addresses, phone numbers, email addresses and VIN information, he reported.

[…]

The buyers are data-mining companies, insurance companies, banks, police departments, car dealers, toll companies, school districts, corporations, private investigators, tax-collecting law firms, tow truck companies and electricity companies, to name a few.

Follow this — the biggest loophole. In Texas, it’s against the law for companies who buy the information to use it to sell to us. So to get around that some companies sell the lists to other marketing companies, which go ahead and use the information to sell — and annoy us.

Because our information isn’t sold directly to marketers, the state doesn’t have to give us a privacy statement when we buy a car or apply for a driver’s license. We don’t get to opt out, as residents of California are now allowed to do.

State lawmakers could fix this, giving us privacy statements and allowing us to opt out of the information sold. Or they could go one better and prohibit the sale of the databases entirely. Other states do.

If you bring this up, state departments other than DMV complain loudly about how these are open records that often can help consumers. (For example, your car is towed, and the towing company can figure out who it belongs to). Besides, selling our data makes a lot of money for the general fund.

One way to see how loosey-goosey Texas is with our information is on the paid subscription lookup site, PublicData.com.

Years ago, there were multiple states listed where you could quickly look up a person’s driver’s license information. Now there’s only Florida and Texas. The other 48 now have higher standards of privacy.

Same goes for vehicle information. Only five states are listed for searching, but four are marked “[OLD].” The fifth is up to date and active. That’s us.

If you get unwanted spam email, postal mail or phone calls and wonder how they got your information, often enough it’s because of our state’s lax laws. Thank you state leaders.

When it comes to cheap and easy data distribution that violates our privacy, we’re number one. Hoo-ray for Texas.

See here for the background. California has a data privacy law that is modeled on the European GDPR scheme. I work with GDPR quite a bit, and it gives people a lot of control over their data while putting some real teeth into enforcement. One of the main ways that GDPR works is that it requires notifications to affected individuals when their personal data is stolen, deleted, or otherwise inappropriately accessed. That’s a lot better than what we have now.

There’s some federal data privacy legislation out there, which largely has the support of the big players like Facebook and Google, which on the one hand means it has a chance to pass but on the other hand means it’s not anything those companies consider to be bad for their business models. I’d rather see something more stringent than that – to me, GDPR is a starting point. We’re not going to get anything like that in Texas, I feel confident saying that. But feel free to call your State Rep and State Senator and tell them that you would like to have the ability to opt out of having your drivers license data sold by DPS. The amount the state takes in for these sales is pennies compared to the state budget. We can very easily do with less of that.

UPDATE: This Slate story about the need for a federal data privacy law is a good read, and addresses the ways we can learn from GDPR for an American version of that law.

Crossing a red line

Will Greg Abbott notice?

North Texas crossed a critical threshold in the number of hospital patients fighting COVID-19 that could trigger bar closings and lower occupancies at stores and restaurants if such cases don’t decrease within a week.

With more than 2,300 patients testing positive for the coronavirus in the 19-county hospital region, 15.05% of all beds were occupied by a person with COVID-19, according to state data.

Hospitals had been approaching the 15% red line — set by Gov. Greg Abbott in October — for several days before the Thanksgiving holiday as the state continued to report record-breaking numbers of new coronavirus cases. On Friday, Texas reported 2,473 new cases and 51 new deaths — a drastic drop compared to recent results likely due to labs being closed for the holiday.

Currently, most businesses in the area may operate at 75% capacity. But under Abbott’s Oct. 7 executive order, businesses will be forced to limit capacity to 50% if they are in a region where more than 15% of hospital patients have tested positive for the coronavirus for seven consecutive days. The rate must drop below the red line for one week before business capacity can rise again.

“As the number of positive cases grows, our health care heroes need your patriotism and sacrifice,” said Dallas County Judge Clay Jenkins in a statement Friday. “Please put off get-togethers and avoid crowds to protect public health and the economy.”

The 19-county region includes both Dallas and Tarrant counties as well as smaller counties, including Rockwall, Cooke and Hunt.

A total of 8,518 people were in a Texas hospital Friday with COVID-19, the state reported. That’s about 2,400 shy of the state’s peak, set in July.

Nine of the state’s 22 regions reported at least one day above the 15% threshold this week. And another hovered just below it Friday. The region that includes El Paso was by far the worst, with about 35% of all its hospital patients fighting COVID-19.

Abbott on Friday tweeted a rosier outlook, highlighting that the rate of infected patients at El Paso counties had dropped for two weeks in a row, and the state’s positivity rate has been declining.

Earlier this month, Abbott rejected the idea of once again scaling back the economy statewide. Another shutdown would have a disastrous effect, he said. At the time of his comments — just eight days ago — six of the state’s regions were above the line.

At this point, we’ve basically surrendered. I have no expectation that Abbott will take any action, other than maybe to cheerlead treatment options, for those who will be able to use them. If you don’t want to be complicit in this, do your part – wear your mask, maintain social distancing, avoid public gatherings, and so on. I don’t know why our leadership is so terrible, but it is and it’s up to us to keep our own selves safe.

The vaccine distribution challenge

Having a vaccine for COVID-19 is wonderful. Being able to make it available to everyone who needs it is a big challenge.

With cases spiking to over 10 million, the virus is everywhere, and spreading deeply into every corner of the country. This is where the Biden administration will face its biggest challenge, especially as it pertains to rolling out a potential vaccine.

My home state of Texas is a great example. A 2016 report from the Texas Department of State Health Services illustrates the terrible state of rural health care. According to DSHS, 235 of Texas’ 254 counties were medically underserved. There were many isolated counties with little to no access to health care. Some even lacked a single doctor.

This has been a crisis a long time in the making. As the Texas Observer recently noted, in 2019, Texas budgeted $17.7 million for infectious disease surveillance, prevention, and epidemiology—and over $400 million for border security. So even when a vaccine is delivered, it will be going to a state that is understaffed and underfunded.

Lipscomb County, population 3,302 as of 2010, in the northeast corner of the Texas panhandle, doesn’t have a doctor. It is worth noting that Lipscomb County is a 550-mile drive from Austin. Portland, Maine, is a closer drive to Washington, D.C., than those 3,302 isolated souls.

Given this isolation and lack of resources, the vaccines themselves present a logistical challenge alone that borders on the impossible for rural America. The Pfizer vaccine, now the leading contender, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another leading vaccine candidate from Moderna also requires cold storage, albeit not to the same extent, according to the company. Typically, hospitals and large clinics have this capability. Small towns lacking even the most basic health clinics do not.

To deploy the Pfizer vaccine or any other one, health planners will have to figure out a way to deliver it to rural areas while maintaining its required temperature long enough to ensure that the population receives both doses. This scene will be repeated all across small-town America. This presents a big risk: An uncoordinated federal roll out of vaccines requiring ultra-cold storage could leave state and local governments competing for resources much like they were competing for PPE earlier in the pandemic.

The Trib expands on this.

How effectively public health officials can prioritize and distribute millions of doses of the new vaccines across a state that covers 270,000 square miles and more than 170 rural counties will determine how quickly Texas turns a corner in a pandemic that is again surging across the state and pushing hospitals to the brink in West Texas and the Panhandle.

The task is made more difficult because the Texas Department of State Health Services, which is largely responsible for the distribution effort, won’t know which vaccines it’s receiving, and how many doses, until one or more is approved by the U.S. Food and Drug Administration.

They will also have to combat misinformation and persuade vaccine skeptics — and those unnerved by the coronavirus vaccines’ historically swift development — of the benefits of being inoculated. World Health Organization experts have said that up to a 70% vaccine coverage rate for COVID-19 may be needed to reach population immunity through vaccination. In the 2019-20 flu season, only about 37% of adults younger than 65 received a flu vaccine. The rate was about 65% for seniors.

“We haven’t seen any efforts that are this broad since probably a polio vaccination in the 1950s,” said Dr. Mark McClellan, a former head of the FDA who has advised Abbott about the pandemic.

“The people who are most likely to benefit from vaccination are people who may have difficulty connecting to health care,” such as elderly people and residents of low-income communities who often lack health insurance, he added — compounding the logistical challenges.

The vaccine is expected to initially be in short supply, and will be first distributed to a state-selected group of people considered to be essential workers or most vulnerable to being severely sickened.

[…]

It’s still unclear, beyond a list of murky priority groups such as health care workers, who will get the vaccine during the initial months when supplies are scarce. In the coming weeks, a state panel of experts is expected to publish more specific recommendations about who will be eligible for a vaccine and when.

Early estimates from the Texas Department of State Health Services found there are more than 5 million people who are vulnerable or work in front-line jobs that increase their exposure risk. That includes more than 3.9 million people who are 65 or older, more than 638,000 health care personnel, more than 327,000 acute care hospital employees, more than 137,000 nursing home residents and more than 66,000 emergency medical workers.

The state’s adult population also includes more than 9.4 million Texans with underlying medical conditions that could increase their risk for severe illness associated with COVID-19.

So yeah, it’s a big problem, and there are many questions that need to be answered, some of which will spark heated debate. In the meantime, as both stories noted, the pandemic rages on, meaning we could be trying to vaccinate people while we’re still in conditions that still demand social distancing and will put everyone involved in the process at risk. So you know, maybe we should try a little harder to contain the spread right now. Just a thought.

UPDATE: From the Trib:

Health care workers will be the first people in Texas to receive a COVID-19 vaccine once one receives emergency approval from the U.S. government, and on Monday a state panel of vaccine experts and politicians revealed which workers in the health field will receive top priority.

The “first tier” recipients, according to the panel’s new guidelines, include:

  • Hospital-based nurses, doctors, custodians and other workers who have direct contact with patients
  • Staff of nursing homes or other long-term care facilities who work directly with residents
  • Emergency medical services providers such as paramedics and ambulance drivers
  • Home health aides who manage “vulnerable and high-risk” patients

Certainly reasonable. We’ll see how it goes after that.

An ounce of cure

It’s certainly nice to have this, it’s just that there isn’t nearly enough of it.

Texas has received 5,800 doses of the newly approved coronavirus treatment that Gov. Greg Abbott heralded on Thursday and will receive even less next week, underscoring the massive challenge that remains as the state scrambles to tamp down its latest outbreak.

While the medication, made by Eli Lilly, is welcome news to many in the state’s health care community, its supplies are so limited that some hospitals are weighing how to ethically prioritize eligible patients, and others have opted out altogether.

“We recognize that this therapy could provide some modest benefit, but it requires space, staff and additional training around infusions that are hard to come by right now, as we are currently strained just taking care of the patients we have in house,” said Dr. Ann Barnes, the executive vice president and chief medical executive at Harris Health System in Houston.

[…]

Carrie Williams, a spokeswoman for the Texas Hospital Association, said executives huddled Tuesday with state leaders and “were largely very supportive of having the opportunity to have their hands on this therapeutic.”

“It’s an outpatient infusion therapy and requires significant space and staff time, which obviously is taxed right now,” Williams said in an email. “That said, we welcome all the help we can get to decrease demand on hospitals right now.”

Texas is expected to receive another 3,200 doses next week, according to data from the U.S. Department of Health and Human Services. That would make it the second largest state recipient, just behind Illinois.

Still, it’s not keeping pace with Texas’ mounting infections. Health officials reported more than 50,000 new positive cases this week through Friday alone, and there are 152,000 estimated active cases statewide. More than 8,000 people were hospitalized with the virus as of Friday.

And the drug is not a cure-all; in clinical trials, it was shown to reduce hospitalizations among high-risk patients but not eliminate them. Federal officials have said they expect close to 400,000 doses to be available nationwide through the end of the year; 80,000 of those have already been distributed.

To be effective, the treatment has to be administered early in an infection, before severe symptoms emerge, and it is meant only for people over age 65 who have chronic conditions such as diabetes or high blood pressure. It’s administered intravenously over the course of an hour.

In Lubbock, where cases are surging and the governor traveled on Thursday, hospitals received 172 doses this week, according to Dr. Drew Payne, a physician and associate program director at Texas Tech University. He said they have scrambled since to determine how best to get the doses out and hoped to begin administering them over the weekend.

“It’s good to say, ‘Hey, everybody needs this medication and we need to give it out,’” Payne said. “But then the logistics of having nursing staff, a place to bring COVID-positive patients into, a way to give that medication, a plan if there’s an adverse reaction to that medication — those are all things we’ve been dealing with.”

Lubbock reported nearly 500 new positive cases on Friday, with 5,700 active cases overall.

See here for the background. The numbers are clear – this new treatment will help at the margins, but we need to bring down the number of new cases. Until we really prioritize that, it’s all just band-aids.

DPS needs to do better with data protection

Oops.

You’ve been hacked. We’ve all been hacked.

No one else has said it, but The Watchdog will. This is likely the largest and one of the more significant data breaches ever to hit Texans.

About 27.7 million Texas driver’s license holders are affected.

If you haven’t heard about this, that’s part of the problem. It’s almost like no one wants you to know.

Why 27.7 million affected licenses when Texas’ total population is around 28 million? Because the number includes former state residents and dead people who were issued licenses before February 2019. So, it includes just about everybody who held a Texas license going back an unknown amount of years. It doesn’t include children.

The Watchdog has the story.

Yes, the information involved here is already available on a paid data site such as PublicData.com, although that site is not always current. But there you have to look up each individual. With this breach, all the information is already bundled and in one place.

What do the crooks have? Your license information (name, address, DL number), the color, model, year and VIN of your vehicle and the lender to whom you make car payments.

I’ll show you how this happened, what crooks can do with the information and how you can be prepared.

The culprit here is a company you probably never heard of — Vertafore of Denver, which, like many companies, buys data from state governments. Vertafore works with the insurance industry to concoct ratings that help agents, brokers and others.

“As a result of human error,” Vertafore says in a news release, “three data files were inadvertently stored in an unsecured external storage service that appears to have been accessed without authorization.”

Someone found the information and grabbed the files before Vertafore realized it, the company says.

The FBI and state law enforcement are investigating.

It appears to The Watchdog that although this data breach began in March and continued to August, our Texas Department of Motor Vehicles, which stores vehicle information, and the Texas Department of Public Safety, which handles licenses, probably didn’t know about the hack until recently because their own databases were not compromised.

There’s more and you should read the rest, including the bit about some likely ways that the attacker could use this information. It could have been worse – no Social Security numbers were stolen, apparently – but it’s still not great, and the complete ignorance about the theft by DPS and DMV is not great at all. Putting my cybersecurity hat on for a moment, DPS and DMV need to do a thorough audit of the security policies and processes used by everyone that has access to their data, because those are clear points of vulnerability. It doesn’t matter how sound DPS and DMV’s own security practices are if their business partners are lax.

(This would a fine opportunity for a member of the Legislature to file a bill that mandates minimum standards for third parties that handle personal data, and for the state agencies that do business with them to proactively ensure they are doing it right.)

The other thing DPS and DMV – and any other state agency that handles personal data – need to do is to subscribe to a service that scans the Internet for data of theirs that may have been stolen. (Experian either does this themselves or subscribes to someone who does, which is how they knew about it before it was officially announced.) It’s an article of faith in the cybersecurity world that security incidents and data breaches are going to happen, so a top priority has to be to detect them as quickly as possible so the loss can be minimized and the damage can be remediated. The history of most large scale cyber incidents is that the attackers had been operating inside the victimized firm for months, sometimes more than a year, before their activities were discovered.

There’s not a whole lot more info about this out there – ZDNet and Insurance Journal add a little more, but that’s really about it. I do hope the state demands a full report from Vertafore, and learns lessons from it. Next time it could be more serious than this.

Prevention > treatment

I mean, more treatments for COVID is a good thing, but you know what’s better? Not getting COVID in the first place. Maybe we can try doing better on that?

Gov. Greg Abbott traveled to Lubbock on Thursday to tout a newly approved coronavirus treatment, without saying how many doses are available or announcing any new restrictions to slow the virus’s spread as infections continue to surge.

Speaking at his first news conference on the pandemic in over two months, the governor said the treatment, made by Eli Lilly and similar to the one that President Donald Trump received last month, has already been distributed to Lubbock and other areas with overcrowded hospital systems, including Midland, Amarillo and El Paso.

“They have enough right now where they can begin the process and treat patients at least for the next several days,” Abbott said. He said he expects additional treatments to arrive in the coming weeks, as well as the first few shipments of a coronavirus vaccine, which could arrive by late December and would go to first responders.

“The cavalry is coming,” he said.

The governor added firmly that the state will not be locking down again, a measure used this spring to slow the initial wave of infections, and insisted that local officials have all tools they need to slow local outbreaks, including a mask mandate in place since the summer and mandatory occupancy reductions for regions where the number of COVID-19 patients exceed 15 percent of total hospital capacity for seven straight days.

In a companion article, Abbott gives three pieces of “good news”, which are this new treatment, that new treatment, and the forthcoming vaccines. All of which is great, and I can’t wait till the vaccines are widely available, but none of that really deals with the current crisis. Effective treatments assumes a fully functional health care system, and right now we have overcrowded hospitals and doctors and nurses who are getting thoroughly burned out. I also assume these treatments aren’t free, and in case you’d forgotten the state of Texas is one of the plaintiffs in a lawsuit that if successful would take away health insurance from millions of people – that’s on top of the millions who already don’t have it here in our state. Plus, and I can’t say this often enough, the economy is not going to get back to full steam until people feel safe from the virus. It’s not enough to say “if you get sick we’ll help you get better”, especially if you’re a person who is immunocompromised or has various co-morbidities or doesn’t have sick leave or child care or health insurance. How many more people need to get sick and die before Greg Abbott can be bothered to care?

Greg Abbott has no interest in fighting COVID

It is what it is at this point.

On June 26, Texas was reporting 5,102 people had been hospitalized due to the coronavirus, breaking a new record for the state. The positivity rate — the portion of tests that come back positive — had hovered above Gov. Greg Abbott’s “warning flag” level of 10% for more than a week.

Abbott swept into action. For a second time in months, the Republican governor shut down bars and rolled back restaurant capacity. Six days later, he took arguably his most drastic action yet, announcing a statewide mask mandate.

This week, more than 7,400 Texans are hospitalized for COVID-19, and the positivity rate has exceeded 10% for over three weeks.

But the governor’s strategy as the state heads into the holidays is to stay the course, relying on a 2-month-old blueprint to claw back reopenings regionally based on hospitalizations. The mask order remains in place, but last week he ruled out “any more lockdowns,” and tensions are again rising with local officials who want more authority to impose safety restrictions.

“We need the state to step in and lead or get out of the way and let us lead,” Harris County Judge Lina Hidalgo told reporters Tuesday.

Public health experts and elected officials acknowledge they are up against a stronger sense of “COVID fatigue” than ever — a malaise that appears to be reflected in the state response.

“The numbers are quite alarming, to be honest, because it’s not showing any sign of slowing down,” said Rajesh Nandy, associate professor of biostatistics and epidemiology at the University of North Texas Health Science Center. However, Nandy added, “it seems like at this point, there’s not a lot of will, even among people, for a full-scale stay-at-home [order] like [Abbott] did in March because, of course, it has other consequences.”

That much is true, as far as it goes. There are economic consequences for shutdowns. There are also economic consequences for letting the virus rage out of control – restaurants and bars and gyms and so forth may be open now, but lots of people don’t want to go to them because it’s not safe, and no amount of puffy-chested posturing from our Republican leaders will change that. At any time in the past six months, Abbott could have asked one or both of our Republican Senators – publicly or privately – to support another COVID relief bill, so that businesses and their employees that have been affected by COVID could safely shut down and not go bust. You would have to ask him yourself why he hasn’t done that, if he ever deigns to answer questions from the public or the non-sycophantic media again.

I mean, maybe we’ll get some kind of relief package from the lame duck session. Maybe the Dems will win both Georgia Senate runoffs and will have the ability to pass a real relief bill. Maybe enough people will stop doing dangerous things like attending indoor events and going about their lives un-masked, and the infection rate will drop again. Maybe we’ll manage to not die before the vaccines get circulated. Anything can happen, I guess.

Of course, one thing that could happen is that our hospitals get so overwhelmed that the death rate for non-COVID sufferers also spikes:

Since Abbott announced the 15% threshold, it has been the subject of some scrutiny. Abbott initially defined the threshold as 15% of “all hospitalized patients” in a region, though he later changed it to 15% of “total hospital capacity” — or total beds — in a region. That redefinition is problematic, according to hospital administrators in parts of Texas that have seen the most infections.

“They’re assuming that all those licensed beds can somehow be utilized for a COVID-19 surge, and that’s simply not true,” Dr. Brian Weis, chief medical officer at Northwest Texas Healthcare System, said last month during a coronavirus briefing for the city of Amarillo. “By using that number, that overestimates our capacity to handle COVID-19 patients.”

[…]

Exhibit A in the state-local tensions is hard-hit El Paso County. Attorney General Ken Paxton has gone to court to stop the shutdown order that County Judge Ricardo Samaniego issued late last month, saying it oversteps Abbott’s statewide rules. A state appeals court blocked the order for a second time Friday.

Abbott blasted the order shortly after it was issued, saying Samaniego “failed to do his job” enforcing existing rules to slow the spread of the virus “and is now illegally shutting down entire businesses.”

In an interview, Samaniego said the criticism from Abbott felt politically motivated and failed to address the biggest issue El Paso faces — that people are getting sick, being hospitalized and dying at staggering rates. Samaniego said he did everything within his power to limit the spread of the virus. He, like other local officials, wants more authority to take precautions in his county.

“It was about saving lives, not about whether I was right or wrong or he was right or wrong,” he said.

He also noted that El Paso’s share of hospital beds occupied by COVID-19 patients is several times Abbott’s 15% trigger, but it’s still artificially low because the county added 580 spots to its hospital capacity.

“This is a governor that issued a stay at home order,” Samaniego said. “And now he’s upset that I did when my numbers are 10 times worse than when he issued it. It’s just a political approach to our community.”

It’s not just El Paso County, though, where local officials are pushing for more latitude from Abbott. In Lubbock County, where cases have ballooned to more than 400 per day on average in the last week, the county judge, Curtis Parrish, said he is grateful for the state’s help with hospital capacity — the state has provided three large medical tents and personnel to go with them — but that he wants more enforcement power.

“My hands are tied,” Parrish said. “We operate under the governor’s order. We can’t do any detaining.”

In Laredo, the City Council voted Monday to limit private gatherings to 10 people plus household members. City Council member Marte Martinez said he would have liked to do more, such as implement a curfew and beef up enforcement for businesses that violate state rules.

“I felt powerless in my plight to save people’s lives,” said Martinez, a doctor. “You’re going to be in a full shutdown within a few weeks unless the state allows municipal governments and county governments to make more firm action.”

There is especially an urgency in Laredo and its hospital region, where the number of coronavirus patients has exceeded 15% of the capacity for the past three days. That means the state’s reopening rollback will kick in in four days if the figure remains above 15%.

What’s happening in El Paso right now is grotesque and disgraceful. Maybe what happens is that we begin to see death and misery like Italy had in the spring, at such levels and in so many places that even Greg Abbott will not be able to ignore it. I really hope it doesn’t come to that, but I don’t know what short of that will make him take this seriously.

Who’s concerned about the state’s coronavirus spike?

Not Greg Abbott, or Dan Patrick, or Ken Paxton, that’s for sure.

The Oregon governor is calling it a “freeze.” In New Mexico, it’s a “reset.”

Across the country, state elected officials are frantically rolling back their reopening plans to slow the burgeoning surge in coronavirus infections.

But in Texas, Republican leaders remain unwilling to change course in the face of soaring hospitalizations and an early uptick in deaths from the virus that has public health experts increasingly alarmed.

Gov. Greg Abbott has yet to impose new restrictions or allow county officials to take additional measures. Attorney General Ken Paxton has intervened to strike down locally adopted restrictions. Other requests to further limit gatherings, close nonessential businesses or impose stricter mask requirements have been blocked.

On Friday, a state appeals court halted a temporary shutdown of nonessential businesses in El Paso County, where cases have skyrocketed and mobile morgues have been rushed in to handle all the casualties. Paxton and a group of restaurant owners had sued to block the order, claiming the governor has final say on any new restrictions.

“I will not let rogue political subdivisions try to kill small businesses and holiday gatherings through unlawful executive orders,” Paxton said in a statement celebrating the appeals court ruling. On Twitter, he added: “We must never shut Texas down again!!”

[…]

Since September, Abbott has relied on a reopening plan that ratchets up restrictions in regions that have growing numbers of people hospitalized with COVID-19; the threshold is now seven continuous days of coronavirus patients filling at least 15 percent of all available beds in that area.

Few if any other states are using a similar threshold, and public health experts have long cautioned against relying on hospitalizations alone because they provide a delayed glimpse into the state of an outbreak — it takes someone several days to be hospitalized after they contract COVID.

Rebecca Fischer, assistant professor of epidemiology and biostatistics at Texas A&M, said it’s important to consider multiple factors, including the rate at which people are testing positive for the virus, emergency room visits and infections at nursing and other long-term care facilities. And she said local governments need decision-making power to best respond to their situations, which may differ even within a given region.

“When I see county judges that are trying so hard to work toward the public health of their constituents and then are just cut off and told no, it kills me,” Fischer said. “Everybody in the public health realm is left scratching their head as to why that would be the case.”

Let’s be clear:

1. They don’t care. Abbott doesn’t want to talk about coronavirus. Paxton will sue any local official who tries to take action to save lives. Dan Patrick has never walked back his comments about letting Grandma die so businesses can reopen.

2. They will never give any authority to local officials. If anything, there will be further bills in the upcoming Lege to restrict what local officials can do even more.

3. They will go straight to Defcon 1 the minute the Biden administration attempts to take any action to combat the virus.

How many people get sick and die as a result is not their concern. They could not be more clear about this.

We’re number one (million)!

One million COVID cases in Texas. Hooray?

Texas’ grim distinction as the national leader in terms of COVID-19 infections came as little surprise to some local medical experts, who blamed politicians for conflicting messages about the virus and warned the worst is yet to come.

Texas this week breached a milestone of 1 million cumulative cases since the start of the pandemic, recording more infections than any other state in the U.S. For reference, more people have been infected in the Lone Star state than live in Austin, the state’s capitol.

If Texas were its own country, it would rank 10th in terms of total cases, according to data from Johns Hopkins University, placing it higher than European hotspots like Italy.

The big numbers are not a shock in a state that’s home to roughly 29 million people. The number of cases per 100,000 residents is lower here than in about half of the states in the country. But Texas also had more newly reported cases in the last seven days — an average of about 8,200 — than other large, hard-hit states such as New York, California and Florida. Only Illinois has a higher seven-day average.

Dr. David Callender, president of the Memorial Hermann Health System, called the 1 million cases “a sobering statistic.”

“It’s not a surprise in the context of all that’s happened,” Callender said. “But it’s a significant number — 3 percent of the population — and cause for worry about the trend continuing as we go forward.”

Callender attributed the high number to “too much division” in the attempt to contain the virus.

“To me, politics entered in an inappropriate way,” said Callender. “People making a political statement with their behavior — that the pandemic is a hoax, that no one can make them wear a mask — really interfered with efforts. It was the wrong mindset.”

To be fair, California is a couple of days behind us, and may have passed one million by the time I publish this. Of course, California also has ten million more people than Texas, so.

The state’s positive test rate is now 11.24%, compared to 7.64% a month ago.

Hey, remember when a 10% positivity rate was considered to be a “warning flag” by Greg Abbott? You know, as part of his famous “metrics” for reopening the state?

Abbott’s office didn’t immediately respond to messages Tuesday.

Too busy propping up Donald Trump’s ego to deal with this kind of trivia, I suppose.

Meanwhile, in El Paso

The number of coronavirus patients in Texas hospitals has nearly doubled since October, and average infections are at their highest point in almost three months — leaving health officials bracing for a potential crush of hospitalizations going into the holidays.

In El Paso, hospitals are so overwhelmed with COVID-19 patients that in early November the Department of Defense sent medical teams to help, and the county has summoned 10 mobile morgues to hold dead bodies. Local funeral homes are readying extra refrigerated storage space, as the number of hospitalized coronavirus patients in the far West Texas city has shot up nearly tenfold since the start of September.

The new wave of infections stands in contrast to the summer surge, when Gov. Greg Abbott held regular press conferences about the virus and mandated that face coverings be worn, earning him the ire of the far-right. Now, state officials seem reluctant to crack down on the virus’ spread by further curtailing economic activity — and are fighting the El Paso county judge’s attempt to impose a curfew and a stay-at-home order in the face of record-breaking cases.

The state will not do anything to help, and you local leaders are not allowed to do anything to help. You’re on your own. If you’re very lucky, maybe you won’t have your health insurance taken away while you recover. Did I mention that disaster and emergency response ought to be a big theme of the 2022 election? Texas Monthly has more.

UPDATE: Nothing to see here.

Will Greg Abbott ever talk about COVID-19 again?

Signs point to No.

On Wednesday, Gov. Greg Abbott knocked on doors in the Fort Worth suburbs, fist-bumping with police officers and warning residents that Democrats want to raise their taxes.

That night, he opened Game 2 of the World Series at Globe Life Field in Arlington, belting out a hearty “play ball” before a stadium partly filled with cheering fans.

With the Nov. 3 election fast approaching, the state’s top Republican is in full campaign mode, trying to block Democrats from retaking the Texas House.

But away from the choreographed appearances, the governor is facing another challenge: Coronavirus infections are rising again, filling up hospitals in parts of the state. Unlike when cases mounted earlier this summer, Abbott has been all but silent about COVID-19’s resurgence.

The governor hardly has mentioned the uptick, which has been most severe in parts of North and West Texas. In news releases, he has announced that he’s sending resources and medical staff to hot spots, but he has downplayed or failed to even mention the outbreaks — part of a third wave sweeping the South and Midwest.

Abbott hasn’t held a public briefing on the pandemic in more than a month.

For a governor who made a point of being on television every night as cases spiked this summer, making himself the face of the state’s response, the silence is notable and likely strategic.

“There’s no advantage to Abbott coming out now to acknowledge the spiking numbers, which say Texas isn’t doing a good job, which say he isn’t doing a good job,” said Brandon Rottinghaus, a political science professor at the University of Houston. “With a week until the election, that would not be beneficial for him.”

[…]

Nearly 5,000 people were hospitalized Thursday with COVID-19, a 55 percent jump since Oct. 3. The average of new daily infections has been rising steadily for two weeks, and the rate of people testing positive for the virus is now just shy of 9 percent, after dipping to a low of 6.3 percent in September.

In Tarrant County, where Abbott appeared Wednesday, health officials have warned residents of substantial community spread, meaning the virus is being transmitted through workplaces and schools.

“The signs are pointing to a big surge coming,” Tarrant County public health director Vinny Taneja told WFAA-TV in Dallas on Wednesday.

Abbott has been an important figurehead in the state’s coronavirus response. When the number of people hospitalized with the coronavirus reached 5,000 in late June, he responded by closing the bars and cutting maximum occupancy for restaurants to 50 percent. He later issued a statewide mask mandate, which remains in effect.

Asked about the new trends Wednesday as he door-knocked for a fellow Republican, Abbott told reporters the state is preparing for a vaccine rollout as soon as late November, a claim that conflicts with remarks from top federal health officials.

The state’s own health officials aren’t planning for a wide rollout of a potential vaccine until July of next year.

Earlier this month, amid mounting pressure from conservatives, Abbott released a video announcing bars could open in counties with local approval, hoping to show a state that had put the worst of the pandemic behind it as voters prepared to head to the polls.

“The good news is that even with more businesses opening, even with more students returning to school and more gatherings like football games, Texans have shown that we can contain the spread of COVID,” Abbott said.

Anyone remember Abbott’s four metrics for reopening? Because I’m pretty sure he doesn’t at this point. Part of the problem, I admit, is that everyone is focused on the election – I sure am – and that means there’s basically no public pressure on Abbott to take action. But this has been building for weeks, and we’ve got kids back in schools while bars are open and people are attending live sporting events – college football appears to be a non-trivial factor in community spread – while a bunch of jackasses are going around the state demanding that we open up even faster. And of course there’s a malevolent President who’s doing all he can to ensure that things are getting worse. Is anyone surprised that Greg Abbott can’t be bothered to at least remind everyone that they should be wearing masks and avoiding crowds?

As little as I think of Abbott, I do expect he’ll have to start talking about this again after the election. If nothing else, we’ll be embarking on a legislative session soon, and we need to decide how we’re going to handle that. I just hope we get something that resembles leadership from Abbott before too many more people are hospitalized or dead.

So what’s up with that National Guard story?

Hell, I don’t know.

Governors can deploy troops for numerous reasons, from natural disasters to border security.

But observers found it rare to the point of extraordinary when the Texas National Guard revealed that Gov. Greg Abbott has directed troops be prepared to respond to disturbances after the Nov. 3 election in major cities across the state.

Abbott has not explained his reasons, so far.

Ben West, a security analyst at the RANE subsidiary Stratfor, a consulting firm, said he anticipates most of the forces will be sent to Houston and Austin, which saw the bulk of the state’s racial justice protests this summer. Guard officials have compared the new mission to its response in June to the unrest.

While an election-related deployment is uncommon, 2020 might be the exception, West said.

“When everything is just upside down, things that in any other year would have been extraordinary get lost in the wash,” he said.

The governor has pushed hard in recent weeks to convey to voters his allegiance to law enforcement, and has proposed new laws that would stiffen punishments for unruly protesters, including mandatory jail time.

The Guard said Monday it would send up to 1,000 troops to Houston, Austin, Dallas, Fort Worth and San Antonio as early as this weekend. A top guard official, retired Maj. Gen. James K. “Red” Brown, said the deployment was in case of “postelection” disturbances, to support local law enforcement and the Texas Department of Public Safety.

He said the guardsmen’s role would be similar to that during last summer’s George Floyd protests, and the troops would act “as we previously did to deter any civil disturbance at sites in various cities in Texas.”

This was the original story. Since then, Abbott has assured officials in San Antonio there will be no troops sent there after they complained, and there was a clarification that none of the troops would be sent to polling locations. On Wednesday, Abbott finally spoke about the issue.

Gov. Greg Abbott on Wednesday answered questions about the deployment of Texas National Guard troops to Texas cities on Election Day, saying they will play no role whatsoever in the election process.

“Our job is to make sure that cities are safe and along those lines, we want to make sure that in the event there are any protests after the election that we will have adequate personnel in place to make sure that we will be able to address any protests that could turn into riots,” the governor said.

When asked specifically about the assignment of troops to Houston, Abbott indicated those decisions will be made on an as-needed basis.

“It is erroneous to say we will have a presence here,” he said.

My guess is that this was a typical politics-first move by Abbott that wasn’t very well thought out and neither took into account any stakeholder input, nor anticipated their reactions. It will probably not amount to much in the end, which is also typical of Abbott. I suppose this is as good a place as any to point out that violence from far-right groups is a much greater threat than people protesting police brutality, though I know there’s a zero percent chance Abbott knows or is much interested in that. It is what it is, as they say. The Press and the Trib have more.

“On the cusp” of another COVID surge

The numbers are already trending up. You know what that means.

Cases of COVID-19 in parts of Texas surged to near catastrophic levels this summer as some hospitals were forced to put beds in hallways, intensive care units exceeded capacity and health officials struggled to stem the tide of the virus.

After peaking in late July and August, cases fell and leveled off in September, and the state’s seven-day positivity rate — or the proportion of positive tests — reached its lowest point since early June.

But health officials are now eyeing a worrying trend: New infections are rising again, and the number of patients hospitalized with COVID-19 is also ticking upward. The state reported 2,273 new cases Monday, and the seven-day average was up by 862 from the previous week. On Monday, at least 4,319 patients were hospitalized with COVID-19, far below the more than 10,000 in July, but that number has steadily risen during the last month.

“I’m no longer pondering if we’re going to see a surge,” said Dr. James McDeavitt, dean of clinical affairs at the Baylor College of Medicine. “We’re already seeing it.”

Eight months since Texas recorded its first case, experts say the state is more prepared to handle another wave, but they fear that if the state fails to control the outbreak, it could quickly spiral out of control.

“The question is whether it’ll be a modest surge, or something like we saw in July, or worse,” McDeavitt said.

[…]

At Houston Methodist, one of the region’s largest health care systems, medical staff were stretched thin this summer, said President Marc Boom. At its peak in July, the system’s staff treated nearly 850 patients with COVID-19 each day. Since then, Boom said, the medical community’s understanding of the virus has evolved, along with how to treat the disease.

Remdesivir, an antiviral medication, has shown promising results in minimizing the severity of illness, especially when administered shortly after symptoms develop. Houston Medical was the first hospital to use convalescent plasma, a therapy in which antibody-rich blood from people who have recovered from COVID-19 is administered to ill patients, Boom said.

“We’ve had tons of experience gained, better outcomes, shorter lengths of stay,” Boom said. “But this is still a serious illness.”

While health authorities are better equipped to deal with new spikes, including an adequate supply of protective gear and sizable quantities of drugs like Remdesivir, a fall surge could still be equally as taxing on hospitals, said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association. As colder weather forces people inside and families gather for the holiday season, the chances for transmission increase, she said.

“We certainly have been tested, and we know the beast that it is, and have shown that we were able to make it through those first two spikes,” Kroll said. “But we don’t want to test the limit by putting patients into hospitals.”

See here for the previous update. It’s getting bad all around the country, too. Just a reminder, the July surge was bad, and it took Greg Abbott way too long to react to it. In the meantime, various assholes have decided that it’s a good use of their time to sue everyone in sight to limit the government’s ability to respond to COVID-19. I have one small bit of local optimism in that Harris County has not backed down from being at the top threat level even as the numbers were improving. Our numbers are also trending up, but they’re not as bad as other places. Yet, anyway.

“The trends are going in the wrong direction,” said William McKeon, president of the Texas Medical Center. “You hate to see the sacrifices we made and the successes we achieved lost because people let their guard down.”

Dr. Marc Boom, president of Houston Methodist, said, “We’ve definitely turned the wrong corner. The numbers aren’t growing in an out-of-control fashion, but there’s no doubt we’re in a significant growth trend that we need to stop before the holiday season.”

[…]

The Houston numbers are well below those in other parts of the country, particularly the Midwest and the West. As of Monday, 16 states had added more COVID-19 cases the past week than in any other seven-day period.

The surge is even greater in Europe. There the total of new cases in the five most-affected countries — France, the United Kingdom, Russia, Spain and the Netherlands — was nearly 42 percent greater than the U.S. increase a week ago.

Nor does Houston’s increase compare to the Panhandle and El Paso. El Paso health officials Monday reported their highest number of COVID-19 hospitalizations since the pandemic began — 449 in one day — and said just seven of the city’s ICU beds were unoccupied.

Still, increases in Houston area’s key metrics since early October are cause for concern, said local health officials. Those provided by the Texas Medical Center include:

• The rolling average of 497 COVID-19 cases reported the week ending Sunday represents a 33 percent increase from late September, when the number was 373. It increased gradually the weeks in between.

• The number of COVID-19 patients admitted to TMC hospitals exceeded 100 last week, up from the 80s the previous week and 70s the week before that.

• The TMC COVID-19 test positivity rate, 3.4 percent early in October, has been at 3.9 percent the past week, an 8 percent increase.

• The so-called R(t), or reproduction rate, the rate at which the virus is spreading, did drop to 0.99 Tuesday, but that remains a 55 percent increase over the Sept. 29 rate of 0.64, when the spread was decreasing. The rate last week hit 1.14, which means the virus’ spread was increasing.

“We’re in a yellow zone, not a red zone”, is how one doctor put it. “COVID fatigue”, they say this is. I get that, but you can see what happens when we start to take this less seriously. Until there’s a widely available vaccine, wear your damn mask, stay out of crowded indoor spaces, maintain social distancing, and hope for the best. At least our mild winter weather means we can largely stay outside. It could be worse.

Don’t look now, but COVID numbers are ticking up again

In the state as a whole.

Texas reported more than 4,100 people hospitalized with the coronavirus on Wednesday, its largest total in six weeks and one that comes amid rising infections in El Paso and North Texas.

Hospitalizations hit a low in late September after a summer surge, but have risen incrementally for the past 10 days, reaching 4,133 on Wednesday. Other key metrics were also up slightly from a week earlier, including the reported rolling average of new daily infections and the number of people testing positive for the virus.

Public health officials said the increase is likely due to a combination of factors, including pandemic fatigue and expanded reopenings, especially bars. Bars were only allowed to begin reopening in select counties on Wednesday, but many have already been opened for weeks after reclassifying as restaurants — a loophole that the state created in hopes it would lead to better social distancing.

[…]

The biggest increases appear to be in West Texas and areas in and around Dallas.

Dallas County Judge Clay Jenkins raised the county’s pandemic risk level back to red on Wednesday, and earlier this week Gov. Greg Abbott sent medical staff and supplies to El Paso to help respond to a wave of new COVID-19 cases.

“With a new and quickly escalating wave of COVID-19 cases hitting North Texas, it is more important than ever that we make good decisions,” Jenkins tweeted.

And here in the Houston area.

Houston-area COVID-19 numbers, trending in a positive direction for the last couple months, have taken a turn for the worse.

Four key coronavirus metrics all show an increase in the past week, according to the Texas Medical Center, which tracks the data for the complex’s seven major hospital systems. Those numbers had started trickling up the previous week in daily reports produced by the center.

The latest numbers from Wednesday’s report:

• The number of COVID-19 cases reported Tuesday, 671, represents a 62 percent increase over last week’s daily average of 412 cases per day.

• The number of COVID-19 patients admitted to TMC hospitals Tuesday, 102, represents an 18 percent increase over last week’s daily average of 86 patients per day.

• The TMC COVID-19 test positivity rate of 3.8 percent represents an 8 percent over last week’s daily average.

• The so-called R(t), or reproduction rate, the rate at which the virus is spreading, hit 1.16 Tuesday, an 18 percent increase in the past week. On Sept. 29, the number was 0.64, which meant the virus’ spread was then decreasing significantly.

The latest metric is probably the most concerning to health officials. A number below 1.0 means the virus is burning out in the area; a number above 1.0 means the spread is accelerating. After 32 consecutive days in which the metric showed the virus was burning out in the Houston area, it now shows the virus is again picking up steam.

And as was the case in the month of June, it’s already too late to stop this. The best we can do now is go back to what we had been doing before to bend the curve back in the downward direction. First and foremost, wear your goddamn masks, and practice social distancing. Don’t be this guy.

As for bars, I want them to survive, and I’ve been up front about the arbitrariness of the state’s definition of what a “bar” is versus what a “restaurant” is. I support the various ways that have been suggested to help bars survive by being more like restaurants, and by enabling to-go and outdoor service. And we really need a federal rescue bill for bars and restaurants and theaters and music halls and other public-gathering businesses that have been so devastated by this pandemic. But we have to be real and recognize that there are no circumstances under which crowding a bunch of people into indoor spaces is a good idea. How many times are we going to have to learn this lesson? The Trib has more.

Abbott to allow bars to reopen

Sort of. It’s kind of the most Abbott thing ever.

Gov. Greg Abbott announced Wednesday that bars in Texas can reopen for in-person service next week — as long as their county governments choose to allow it.

Effective Oct. 14, bars in counties that opt in will be able to resume in-person service at 50% capacity, though all customers must be seated while eating or drinking. The governor will impose no outdoors capacity limits on bars or similar establishments.

“It is time to open them up,” Abbott said in a Facebook video. “If we continue to contain COVID, then these openings, just like other businesses, should be able to expand in the near future.”

But soon after Abbott’s announcement, the state’s two most populous counties indicated they would not go along with the reopening plan. Dallas County Judge Clay Jenkins said on Twitter that he “will not file to open them at this time,” noting that “our numbers are increasing.” Harris County Judge Lina Hidalgo said in a statement that “indoor, maskless gatherings should not be taking place right now, and this applies to bars, as well.”

In addition to bars being allowed to reopen, businesses currently limited to 50% capacity may now expand to 75% capacity — including establishments like movie theaters, bowling alleys, bingo halls and amusement parks.

But Abbott said in his order that bars in regions of the state with high hospitalizations for coronavirus won’t be able to reopen. He defined those regions as areas where coronavirus patients make up more than 15% of hospital capacity.

“It is time to open up more, provided that safe protocols continue to be followed,” Abbott said. “If everyone continues the safe practices, Texas will be able to contain COVID and we will be able to reopen 100%.”

The announcement drew mixed reviews from bar owners. Some applauded the step, while others complained that Abbott left the power in the hands of counties.

“The truth is we remain closed until someone else makes the decision to open us up based on whatever parameters they deem appropriate — data, politics, personal animus, you name it,” said Michael Klein, president of the Texas Bar and Nightclub Alliance. “Abbott has forced 254 other people to make this decision for him with no guideposts as to how to make that decision. He’s officially passed the buck.”

Klein predicted that most urban counties, where the majority of his organization’s members are located, will not reopen.

You can add Bexar County to that “no bars yet” list as well. There’s a very good reason why most counties will likely decline this invitation from Abbott:

You have to admire Abbott’s consistent strategy of making local officials be the ones who have to make the tough decisions – when he lets them – and otherwise grabbing the power and glory for himself. Naturally, Republican-led counties are all over this, so be sure to keep an eye on the infection rates in places like Montgomery over the next month. To be sure, many bars have been able to operate with various workarounds as restaurants. And for things like outdoor service and to-go service, I support all that. It’s not enough for most bars, and the best thing we could have done about that is allocate a bunch of federal money to help them all – bars, breweries, wineries, distilleries, restaurants, music clubs, hotels, you name it – get through this, to the point where the disease is under control and it is safe for everyone to gather again. Abbott and his buddies were never really interested in any of that, though, so here we are. I feel like I’ve said this before, but I sure hope this works out. I don’t expect that it will, but I hope so anyway.

UPDATE: At least initially, only Denton County among the ten most populous counties will go forward with bar reopenings.

And so the re-reopening begins

Are we really ready for this?

Gov. Greg Abbott announced Thursday that most of Texas will be able to loosen some coronavirus restrictions, including letting many businesses increase their capacity to 75%, as soon as Monday.

Retail stores, restaurants and office buildings, which have been open at 50% capacity, will be permitted to expand to 75% capacity. Hospitals will be allowed to offer elective procedures again and nursing homes can reopen for visitations under certain standards.

The new reopening stage applies to 19 of the state’s 22 hospital regions. The three hospital regions excluded are in the Rio Grande Valley, Laredo and Victoria. Abbott said those regions’ hospitalizations are still “in the danger zone,” which he defined as places where coronavirus patients make up 15% or more of all hospitalizations.

At the same time, Abbott said the state was not yet ready to reopen bars, saying they are “nationally recognized as COVID-spreading locations.” He stressed, though, that the state is looking for ways to let bars reopen safely.

[…]

“Gov. Abbott’s press conference today was notable for what he didn’t say,” state Rep. Chris Turner of Grand Prairie, who chairs the House Democratic Caucus, said in a statement. “There was no mention of a contact tracing program, no mention of improving the state’s unreliable data and no mention of expanding Medicaid to increase access to health care for the millions of Texans who are uninsured.”

The Texas Democratic Party said Abbott is “basing his decisions on dirty data.”

Abbott began the news conference by hailing the state’s progress in the fight against coronavirus, saying the “biggest reason” for improvements has been that Texans are taking the pandemic seriously and exercising personal responsibility.

The governor reminded Texans that doctors have said the goal is not to eradicate the virus but to “contain the disease, to limit its harm and to maximize the health care system’s ability to treat both COVID patients as well as other medical needs of the community.”

When it comes to further reopenings, he emphasized the state will consider all data but “rely most heavily” on hospitalizations, calling that metric the “most important information about the severity of COVID in any particular region.” It is also the “most accurate information available on a daily basis,” Abbott said.

To that end, the regions that will be allowed to further reopen must have seen coronavirus hospitalizations make up less than 15% of all hospitalizations for seven consecutive days, according to the governor. If coronavirus hospitalizations rise above the 15% threshold for seven consecutive days in a region, a “course correction is going to be needed,” Abbott said, suggesting the solution would be a reversal of the area’s latest reopenings.

Given that many other countries have essentially eradicated the virus, one could certainly disagree with Abbott’s assertion about what the goal should be. Though to be fair, it does seem impossible to set such a goal while Donald Trump is President, so perhaps this is just Abbott acceding to that reality. The Chron adds some details.

The new regional threshold marks a significant shift for the Republican governor as the state’s pandemic response moves into the fall, with flu season arriving and many schools about to reopen for in-person instruction. He previously resisted committing to a regional approach, and said he would rely on a range of metrics — not just hospitalizations — to determine policies.

But the state’s health agency has been dogged by data backlogs, and some counties said they had lost confidence in state metrics such as the number of new daily infections and the percent of positive COVID tests, also known as the positivity rate. While the state has remedied at least some of the issues, hospitalization data have been more reliable throughout the pandemic.

Other large states, including New York and California, are currently using regional reopening plans based on several criteria, including new cases and test positivity. Public health experts caution against relying on hospitalizations alone, since they lag behind infections and therefore provide a delayed glimpse into the community spread of the virus.

All but two of the state’s 22 hospital regions have previously surpassed the new 15-percent threshold, according to the state’s calculation. The governor did not provide the methodology for how they calculated the percentages, and a spokesman did not immediately respond to questions about how the benchmark was selected.

The state has reported nearly 700,000 infections since March and nearly 14,500 deaths, a toll similar to that in other large states, including California and Florida. New York has reported fewer infections but more deaths, stemming from a surge earlier this year.

Texas has been below 10 percent test positivity for at least two weeks now. Earlier this week, state health officials unveiled a new method of calculating the rate, which shows it first dropped below 10 percent in mid August. Abbott has said before that he would consider further reopenings once the state remained below that threshold for two weeks.

Yes, our lousy data quality is an issue. I get that there’s a lot of pressure to let businesses get back to “normal” again. But let’s be real here: One, plenty of people will still not change their habits to what they were in the Before Times until they feel confident that the pandemic is truly under control. Public opinion is clear that most people do not feel this way, and as such this greatly limits the upside of any reopening scheme. Two, we have been down this road before, and the last time we went this way Abbott basically ignored all the metrics that he himself set and just went about loosening restrictions even though none of his own stated criteria were being met. There’s no reason to believe he has learned this lesson. Three, even if we had complete clarity on hospitalizations, that’s a lagging indicator, meaning that by the time the hospitals have started to fill up again, it’s already too late to stop it. Four, see above about the lack of our data quality, which again strongly suggests that even if Abbott is sincere about turning the car around at the first sign of trouble, that first sign may not be at all apparent when it’s happening.

Finally, the reason why people finally started to take the pandemic seriously is because Greg Abbott finally started taking it seriously, and conveying a message that we all needed to be wearing face masks and social distancing and avoiding large gatherings, especially indoors. We certainly haven’t gotten that message from Donald Trump or his biggest toadies like Dan Patrick. If you want to praise everyone for their personal responsibility, then you need to emphasize that they have to continue being personally responsible, which means wearing masks and so on. If that makes the rock-filled heads of Steven Hotze and his ilk explode, then so be it. Abbott loves being in front of the parade, but he does a crappy job of leading it. As I said the last time we re-opened, I really hope this works out. And I really hope Abbott is serious about backing off at the first sign that it isn’t. A statement from Mayor Turner is here, and the Dallas Observer, Reform Austin, the Texas Signal, and the Houston Press have more.

We suck at COVID data, the continuing story

Would have been nice to have known this when it was happening.

State health officials published new data this week that showed the state’s positivity rate was higher in the spring that originally disclosed, even as public officials cited the data to justify business reopenings during the pandemic.

The Department of State Health Services on Monday announced a new method for calculating the positivity rate, or the proportion of positive tests, and conceded the previous method obscured the extent of viral transmission by combining old and new cases. The new formula relies on the date a coronavirus test was administered, rather than the date it was reported to health officials and verified as a case.

As Texas prepared for the first phase of reopening in late April, Gov. Greg Abbott repeatedly pointed to the state’s positivity rate, even as the number of new cases and deaths continued to rise. Announcing his initial reopening order on April 27, Abbott declared that the “COVID-19 infection rate has been on the decline over the past 17 days.”

The following week, the governor downplayed a new single-day record in new COVID-19 cases by again pointing to the positivity rate.

“Despite concentrating on areas where we think there may be a high level or number of people who could test positive, the fact remains that more than 95% of the people who were tested test negative,” Abbott said during a May 5 news conference.

State data at the time placed the seven-day average positivity rate at 5.84%, near the 5% benchmark recommended by the World Health Organization before governments ease restrictions. The actual rate, however, was higher. According to the new method employed by DSHS, Texas’ seven-day average positivity rate was actually 8.4%, near the 10% threshold Abbott had called a “warning flag” indicating a high level of community spread.

Following the reopening of bars, restaurants, stores and child care centers throughout May, Texas saw a surge in cases beginning in June. The state’s reported seven-day average positivity rate under the old method jumped from 4.27% at its lowest point in late May to 17.4% at its peak in mid-July. After revising the data, the state’s new chart shows that the positivity rate jumped from 5.81% in May to a peak of 21% in early July.

See here, here, and here for earlier entries in this chronicle. This stuff is hard, I don’t want to minimize that. Doctors and scientists have made mistakes and have changed their tune on COVID-related matters over time, as new data has come in and revised our understanding of what we thought we knew. Maybe no one could have known this at the time, I’m not in a position to judge. But as we’ve said before, the state rushed to reopen on Greg Abbott’s orders even as the Abbott-defined metrics for reopening were not being met. Now we know we were even further from the desired levels than we thought, and many more people have gotten sick and died or are suffering from long-term effects of the virus. We can have some level of sympathy for Greg Abbott, we can recognize that anyone would have made bad decisions if they were given bad data, and still hold him responsible for the outcome. His decision to reopen as he did was risky at the time, and it’s so much worse now. That’s all on him.