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September 6th, 2021:

Just a reminder, no one is enforcing Abbott’s mask mandate ban

In case you had forgotten.

While Republican Gov. Greg Abbott is speaking out against mask mandates in schools and suing to stop some Texas school districts from enacting them, in reality his order banning such mandates has gone largely unenforced — so much so that the federal government doesn’t consider it active.

Abbott threatened $1,000 fines for officials who try to impose mask mandates, although no such fines have been handed down. And if he wanted to, Abbott could send state troopers or deputize the Texas National Guard to enforce his order, as he has done on the border, but he hasn’t. Texas Attorney General Ken Paxton, meanwhile, has a published list of 71 non complying cities, counties and school districts; is fighting in court with at least six of them and sent letters threatening more legal action to others.

But in the court filings from the lawsuits, Paxton has acknowledged that neither he nor Abbott will directly enforce the ban on mask mandates, instead leaving it to local district attorneys, some of whom are already on-record saying that they don’t intend to prosecute.

Abbott’s own Texas Education Agency on Aug. 19 said that the ban on mask mandates would not be enforced until the courts have resolved legal challenges to his authority to do it. And the federal Department of Education chose Monday not to open an investigation into the matter in Texas, even as it launched probes of five other states with active bans.

[…]

The five largest counties in the state are Harris, Dallas, Tarrant, Bexar and Travis. The district attorneys for Harris and Bexar counties have already announced they don’t intend to prosecute school districts over mask rules, and a prosecutor with Travis County said the office would remain focused on violent crime, although they would evaluate the situation on a case-by-case basis.

Tarrant County did not respond to a request for comment, and a spokeswoman for Dallas County said: “This issue is working its way through the civil courts. At this point in time — until that’s concluded and depending on how that’s concluded — there’s no reason to consider a position on that.”

On Monday at a House Public Education Committee hearing, Rep. Steve Allison, a San Antonio-area Republican, acknowledged there’s “an appearance of dysfunction” in government right now over the mask orders and Abbott’s ban.

See here and here for the background. I’m not sure why the Travis and Dallas DAs are being so equivocal, but it doesn’t really matter. There’s no way they’ll prosecute anyone over this, not if they want to avoid having their asses handed to them in the next primary election. We all know this is about Greg Abbott trying to look macho for the Republican primary voters. There’s no need to help him with that in any way.

The contract health worker surge

Don’t know how sustainable this is.

Dr. Esmaeil Porsa, president and CEO of Harris Health System, said the hospitals in the system were at a breaking point when he learned that 100 temporary medical workers were being sent to help.

As cases surged, the hospitals were admitting more children and pregnant women with complications from COVID-19, and patients who needed intensive care waited in emergency rooms for ICU beds to become available.

The nurses, respiratory therapists and other contract staff “definitely arrived here at a pivotal moment,” Porsa said. “They did exactly what I had hoped that they would do, which is allowing us the opportunity of a couple of things: to provide a little bit of relief for front-line staff who have been running around ragged, but also created an opportunity for us to expand our capacity.”

[…]

Gov. Greg Abbott announced the Texas Department of State Health Services would deploy state-funded relief workers to hospitals, and 8,100 have either arrived from other states or are expected soon.

It’s the second time the state has taken such action. At the height of the state’s winter surge, almost 14,000 medical workers were deployed across the state, according to DSHS. From July 2020 to early August of this year, the state spent more than $5 billion in federal disaster funds and coronavirus relief funds on medical personnel.

Abbott’s move came after hospitals and local health officials complained that they were having to outbid each other to hire contract nurses amid a statewide shortage of hospital staff.

W. Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, said that competition among hospitals meant “they’re going to take from Peter to give to Paul, so to speak. That’s why using the state with their purchasing power [is important].”

The new push to bring more health workers to Texas comes as many have reached their limits, said Carrie Williams, spokesperson for the Texas Hospital Association.

“This surge has come faster and stronger than previous surges, and it comes at a time when the frontline [worker] is burned out,” Williams said in a statement. “We were already starting from behind when this surge hit.”

According to DSHS, the state’s hospitals requested more than 15,000 temporary staffers between Aug. 12 and Aug. 25. As of Aug. 25, almost 4,000 have been deployed, with most going to regions with the state’s most populous counties and metro areas.

[…]

Health officials continue to stress that the main way to reduce the need for additional staff is clear: more vaccinations. As of Aug. 25, about 47% of Texans were fully vaccinated.

Since Jan. 1, Porsa said, everyone who has died at LBJ Hospital and Ben Taub Hospital from COVID-19 has been unvaccinated.

“Space is not unlimited, resources are not unlimited,” Porsa said. “At some point it doesn’t matter how many nurses you throw at the problem, we are going to arrive at a situation where we’re not going to have enough clinicians, we’re not going to have enough doctors, we’re not going to have enough something else.

“We will run out of options at some point, and this is really really important for people to realize that this cannot go on forever, and they know what the solution is.”

It’s still not clear to me how there could even be that many not currently working medical staff out there to be brought in, but they do exist in some number, for which we are grateful and lucky. It’s also not clear at what point demand will outstrip supply, and as noted above, we may run into other limits even sooner than that.

How long can we last? There’s actually a tiny bit of cause for optimism in the most recent data.

The average number of daily COVID hospitalizations in the Texas Medical Center dropped for the first time since early July from a record 390 patients to 388, the medical center reported Monday.

The metric reflects the daily average of hospitalized patients over the previous week. The drop comes amid declining COVID hospitalizations both nationally and statewide.
A three-day decline in total COVID hospitalizations in Texas brought the number to 13,557 on Saturday, the most recent day for which data is available. The Centers for Disease Control and Prevention also reported a drop in the average number of new daily hospitalizations nationwide, from 12,354 on Thursday to 12,051 on Friday. More recent national data is not yet available.

Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine, said the decline is part of the natural course of the pandemic.

“When you see an outbreak like this, the virus kind of runs through the population until it gets to the point where it starts running out of people to infect,” he said, adding, “That does not mean herd immunity.”

He warned that the virus still has room to spread, especially as schools reopen. In an interview last week, McDeavitt said hospitals will continue to feel the strain of the current surge as cases decline.

Burnout among nurses, lingering staffing shortages and the record number of hospitalizations all factor into a longer recovery period.

“From the peak, we’re probably still a month-and-a-half to getting to something that feels like business as usual,” he said last week. “So best case, we’re into October now before we start to get some relief.”

So don’t get too cocky. It’s good that maybe we’ve peaked and will start to see a decline, but we’re still a long way out from where we were in May and June, and we could easily reverse course again. We need to keep getting people vaccinated, because the alternative is more of what we’re going through now.