Off the Kuff Rotating Header Image

November 24th, 2020:

Counties of interest, part four: Around Bexar

Part 1 – Counties around Harris
Part 2 – Counties around Dallas/Tarrant
Part 3 – Counties around Travis

Pop quiz, hotshot: Close your eyes, or cover the table below, and name for me the seven counties that border Bexar. Go ahead, I’ll wait.


County       Romney    Obama    Trump  Clinton    Trump    Biden    Shift
=========================================================================
Atascosa      7,461    5,133    8,618    4,651   12,020    5,865   -3,827
Bandera       7,426    1,864    8,163    1,726   10,050    2,503   -1,985
Comal        39,318   11,450   45,136   14,238   62,260   24,369  -10,023
Guadalupe    33,117   15,744   36,632   18,391   47,423   28,706   -1,344
Kendall      14,508    3,043   15,700    3,643   20,064    6,008   -2,591
Medina       11,079    4,784   12,085    4,634   15,599    6,731   -2,573
Wilson       12,218    4,821   13,998    4,790   18,457    6,350   -4,710

Unless you’re a true geography nerd, or just a very aware (or well-traveled) resident of the area, I’m guessing you didn’t get all seven. Comal, which you pass through on your way to Austin, and Guadalupe, to the east as you travel I-10 to or from Houston, are the gimmes. They’re also the two largest, with Comal and more recently Guadalupe blending into Bexar from a development perspective. I’ve talked a lot about Comal County, which has tripled in population since 1990 and which puts up big numbers for the Republican Party; I call it Montgomery County’s little brother, but it’s doing its best to try to catch up. I think it feels a little to me like Montgomery because it’s also this booming suburb a few miles away from the big city, with enough distance to be its own separate entity but with any remaining vacant space between them rapidly vanishing.

Guadalupe, on the other hand, feels more remote to me because for most of my time in Texas, there was very little between Seguin and Loop 1604, and even then there wasn’t much between 1604 and Loop 410. That change is more recent, and to my eyes more dramatic since I don’t travel that way all that often and had just been very used to the former emptiness. It’s really interesting to me that while Comal is still getting redder, Guadalupe is more or less holding in place, with Republican growth only slightly outpacing Democratic growth as its population has blossomed. Guadalupe feels more rural to me while Comal feels more suburban, but maybe that’s because I’ve spent much more time in New Braunfels (I have family there) than in Seguin. I’d love to hear more about this from anyone in this part of the state.

I just don’t know much about the other counties, from the north through the west and around to the south and southeast of Bexar. I’ve been to Kendall (in particular, the town of Boerne) and Bandera, but not since the 80s. Kendall and Medina seem like long-term candidates for suburban sprawl, as both have a piece of I-10 and Medina has I-35 running through it. I know nothing at all about Wilson and Atascosa. I’m going to stop here because I don’t want to babble, but again if someone reading this can tell us more about the future prospects in these counties, please do so.

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.

We might get better Census apportionment data

Some good news.

The Census Bureau has identified issues in the data from the 2020 decennial census that will take an additional 20 days or so for it to fix, and thus delay the release of survey’s apportionment data until after President Trump leaves office, TPM has learned.

According to a person inside the Census Bureau, the additional time it will take to reprocess the data in question has pushed back the target date for release of the state population counts until Jan. 26 – Feb. 6.

That would mean President-elect Joe Biden will be in the White House when the Census Bureau delivers to him the numbers for him to transmit to Congress for the purposes of determining how many House seats each state will get for the next decade.

President Trump had been seeking to exclude undocumented immigrants from that count, with a policy that several lower courts have deemed illegal in rulings Trump is hoping the Supreme Court will overturn. Excluding undocumented immigrants from that count would decrease the House seats given to immigrant-rich states like California, and increase the representation for whiter, more Republican parts of the country.

The issues that the Census Bureau has identified in the data are standard for any census, the source told TPM, and it is routine for the Census Bureau to have to do this kind of reprocessing.

Shortly after this story was published, Census Director Steve Dillingham confirmed the “anomalies” in a statement to TPM that made no explicit mention of how fixing them will impact the timeline for releasing the data.

“During post-collection processing, certain processing anomalies have been discovered. These types of processing anomalies have occurred in past censuses. I am directing the Census Bureau to utilize all resources available to resolve this as expeditiously as possible. As it has been all along, our goal remains an accurate and statistically sound Census,” Dillingham said.

I don’t know if that puts an end to the ongoing Census shenanigans, but anything that takes the process out of the Trump administration’s hands is a good thing.