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contact tracing

A different kind of COVID tracking

Nov 27th, 2020
by Charles Kuffner.
1 comment

Hope this works.

Harris County Public Health will survey residents for COVID-19 antibodies in an effort to determine how many people already have been infected with the novel coronavirus, the department said.

Beginning Sunday, health workers will visit randomly selected homes and ask residents to answer questions and provide blood samples.

Humans produce antibodies, proteins in the immune system, to fight infections from viruses and other pathogens. It can take days or weeks for antibodies to develop following exposure to the coronavirus, and it remains unclear how long they remain in an individual’s blood.

The Houston region has recorded 236,704 COVID-19 cases since the virus arrived here in March, according to a Houston Chronicle analysis, but health officials estimate this is only a fraction of the total number of infections.

Health officials hope the antibody tests will help the county determine how COVID-19 spread in certain communities, how transmission rates differ between neighborhoods, how effective containment strategies have been and how many residents contracted the virus but never exhibited symptoms.

“This survey is a very important way that local residents can help public health workers fight this virus,” Harris County Public Health Executive Director Dr. Umair A. Shah said in a statement. “By finding out how widespread the illness is, we can develop strategies that will help us control the spread of COVID-19.”

Participation in the program is voluntary, and only selected households are eligible. Teams of health workers wearing yellow vests will make their rounds from Nov. 15 through Dec. 15, from 8 a.m. to 5 p.m.

The point of this survey is to find the people who have COVID but didn’t know it and never got tested for it. This will help us know what the real level of infection is in the county, since the official stats are almost certainly too low. It may also help identify previously unknown hot spots, in the way that wastewater testing can do.

And speaking of official statistics:

Please wear your mask and stay socially distant, y’all. There’s only way one way out of this until that vaccine is ready.

Some superintendents disagree about school opening delays

Aug 20th, 2020
by Charles Kuffner.
Comments are off for this post

It takes all kinds.

Judge Lina Hidalgo

Superintendents leading 10 Houston-area school districts penned a letter this week opposing Harris County’s recommendations for reopening campuses, arguing that face-to-face instruction should resume earlier than health officials suggest.

In their two-page letter, the superintendents say guidance released last week by Harris County Judge Lina Hidalgo and Public Health Executive Director Umair Shah will keep campuses closed too long, denying valuable in-person class time to students. Superintendents are not required to follow the county recommendations, though the guidance serves as a key document in the debate over when to restart in-person classes.

“It is clear that we all have the same goal, which is to return students to in-person instruction as safely as possible, the superintendents wrote to Shah on Monday. “We thank you for the continued efforts of your departments on behalf of Harris County. With that said, we believe that the metrics outlined in the plan you have provided are not attainable to resume in-person instruction in the foreseeable future.”

The superintendents represent Clear Creek, Cy-Fair, Deer Park, Huffman, Humble, Katy, Klein, Pasadena, Spring Branch and Tomball ISDs. Combined, the districts serve about 457,000 students.

In response to the letter, Harris County Public Health officials said in a statement that the organization “has made it abundantly clear that current indicators are not safe to resume in-person activities in Harris County due to COVID-19.”

As the new school year approached and superintendents debated when to resume in-person classes, some education leaders called on county health officials to offer guidance on reopening campuses.

Hidalgo and Shah followed through by producing several public health benchmarks that should be met before in-person classes resume at the lesser of 25 percent capacity or 500 people in a campus. The metrics included cutting the 14-day rolling average of new daily cases to under 400, bringing the test positivity rate under 5 percent and ensuring less than 15 percent of patients in ICU and general hospital beds are positive for COVID-19.

Harris County likely remains at least several weeks away from meeting those metrics. For example, the county recently reported a rolling daily average of about 1,250 new cases and a test positivity rate of 16 percent.

In their letter, the superintendents only mentioned two specific health benchmarks with which they disagreed. The school leaders wrote that the recommendations would “essentially require indefinite closure of schools to in-person instruction while awaiting a widely available COVID-19 medical countermeasure or greater staffing capacity at Harris County Public Health for contact tracing.”

However, the guidance specifies that districts could start to reopen and ramp up to the lesser of 50 percent building capacity of 1,000 people on campus even without a “widely available COVID-19 medical countermeasure.” County officials did not detail what qualifies as a medical countermeasure in their written guidance, and they did not respond to written questions Tuesday.

See here for the background. As a reminder, Judge Hidalgo and Harris County have limited authority here – ultimately, if these districts decide to open, they can. It’s only when outbreaks occur that the county will have more power to step in. Humble ISD has already opened, the others have plans to have at least some students back by September 16. As the story notes, other districts including HISD, Aldine, Alief, and Spring did not sign this letter, but it was not clear if they had been invited to sign it or not.

I get the concern from these districts, and there’s room for honest disagreement. I don’t have any particular quarrel with their approach, though I personally prefer the more cautious path. As Chron reporter Jacob Carpenter notes in these two Twitter threads, the county now meets three out of seven criteria for reopening, and is trending in the right direction for the others. There’s no accepted national standard for what is “safe” to reopen – that’s a whole ‘nother conversation, of course – so one could argue that Harris County is being overly restrictive. Of course, we’ve also seen plenty of schools and universities that brought in students and then immediately suffered outbreaks that forced closures. Bad things are going to happen until this thing is truly under control, and it is not going to be under control any time soon while Donald Trump is President. That’s the reality, and all the choices we have are bad. Which ones are the least bad is still an open question.

Another lawsuit against Abbott over emergency orders

Aug 6th, 2020
by Charles Kuffner.
2 comments

This one is a bit more serious due to the lack of Hotze and Woodfill, but it’s still not a great way to have the debate about this issue.

Five Republican Texas lawmakers are suing Gov. Greg Abbott over the state’s $295 million COVID-19 contact tracing contract to a small, little-known company, alleging the agreement is unconstitutional because it wasn’t competitively bid and because the funds should have been appropriated by the Legislature in a special session.

In the Travis Country district court suit filed Monday, State Reps. Mike Lang, Kyle Biederman, William Zedler, Steve Toth and state Sen. Bob Hall named as defendants Abbott, the Texas Department of State Health Services and the company awarded the contract, the Frisco-based MTX Group.

Abbott and Attorney General Ken Paxton have defended the contract. Abbott did not immediately respond to a request for comment.

The lawmakers are seeking a court order voiding the contract for lack of statutory authorization and deeming unconstitutional the governor’s application of the Texas Disaster Act of 1975, which gives him broad powers in the case of an emergency, in granting the contract.

“The Texas Constitution requires a separation of powers, and that separation leaves policy-making decisions with the Texas Legislature,” the lawsuit states. “These decisions are not changed by pandemics.”

Abbott has declined to convene a special session since March when the coronavirus pandemic began, instead leaning on his emergency powers to issue a series of sweeping executive orders governing what businesses can open, where people can gather in public, and mandating safety measures including wearing face coverings in public.

While the law has been used by governors for years, the time span of the coronavirus-related orders is unprecedented and raises questions about the durability of that legal justification.

As the story notes, the Supreme Court just rejected several Hotze lawsuits relating to executive emergency powers, saying he lacked standing. I don’t know if that is likely to be an issue in this case or not. I still agree with the basic premise that we need to have a robust debate about the parameters of the Texas Disaster Act, including when the Governor should be compelled to call a special session so that the Lege can be involved in the decision-making process. I also still think that this is a lousy way to have that debate, and while these five legislators have more gravitas than Hotze, that’s a low bar to clear. To put it another way, the anti-face mask and quarantine lobby still isn’t sending their best.

There’s no doubt that the contact tracng deal was a boondoggle, and I welcome all scrutiny on it. And I have to admit, as queasy as I am with settling these big questions about emergency powers by litigation, there isn’t much legislators can do on their own, given that they’re not in session and can’t be in session before January unless Abbott calls them into a session. I’m not sure what the right process for this should have been, given the speed and urgency of the crisis. The Lege very much needs to address these matters in the spring, but I’m leery of making any drastic changes to the status quo before then. In some ways, this is the best argument I’ve seen against our tradition of having a Legislature that only meets every two years. Some things just can’t wait, and we shouldn’t have to depend on the judgment of the Governor to fill in the gaps. I hope some of the brighter lights in our Legislature are thinking about all this. The Trib has more.

The contact tracing debacle

Jul 27th, 2020
by Charles Kuffner.
6 comments

Let us never forget about this.

Just as coronavirus infections began rising a few weeks ago in Texas, contract workers hired by the state to track down exposed Texans were spending hours doing little or no work, received confusing or erroneous instructions and often could not give people the advice they expected, interviews and records indicate.

Health authorities around Texas also say they are running into technical snags with new contact tracing software the state has deployed, known as Texas Health Trace, saying it isn’t ready for widespread use in their counties.

The chaotic beginning and technical glitches — combined with exploding case counts and widespread testing delays — have undermined the goals of boosting COVID-19 monitoring statewide and the state’s massive deal for a privatized contact tracing workforce.

“I know that a lot of local health departments are still trying to figure out how to utilize that contract and some have decided to do the work on their own,” said David Lakey, chief medical officer at the University of Texas System and former commissioner of the Department of State Health Services (DSHS). “There is concern with local health department individuals I’ve talked to related to how they are going to benefit related to this large investment from the state.”

DSHS said problems identified by the Houston Chronicle have since been fixed and that “every week” more counties are using its software.

Gov. Greg Abbott’s office said months ago that robust contact tracing capacity would help Texas “box in” the coronavirus. But after the state reopened its economy, infections, hospitalizations and deaths skyrocketed, making it impossible for many health departments to keep up with contact tracing.

“When you kind of jump the gun a little bit and open too soon, and you skip the processes that need to be in place, this kind of thing happens,” Harris County Judge Lina Hidalgo said. “You might have the most successfully designed contact tracing program or you may not, but honestly it’s not gonna make a difference because you’re setting yourself up to fail.”

At the state level, Texas moved to ramp up and modernize contact tracing in May, when the Texas Health and Human Services Commission quietly awarded a $295 million contact tracing deal to little-known MTX Group, a tech startup that has a headquarters in North Texas. Abbott’s office has staunchly defended the emergency expenditure, but it’s been controversial from the get-go.

The bid for the work, which was never publicly posted, was awarded to MTX without input from top state leaders, and more than a dozen legislators subsequently called for the state to cancel the contract.

More recently, four people who performed contact tracing work for MTX or one of its partners raised questions about the tech company’s performance. They spoke to the Chronicle on condition of anonymity because they weren’t authorized to speak on the record about their employment. Three said they fielded only a handful of phone calls during several weeks in May and June.

You can read on for details of the various failures of the program as implemented, and you can see here for more on Texas Health Trace. My point is that having a certain number of contact tracers in place, a number that was never met, was one of the four conditions of reopening set by Greg Abbott. The real failure here, as has been the case with everything else, was the complete lack of effort to meet those metrics that were set out. The failure to do so led directly to the situation we’re in now. The fact that MTX was given a no-bid contract on Abbott’s say-so and no one else’s input is a separate issue, one that deserves a fuller exploration, but not necessarily a main cause of the failure. It’s possible to imagine a scenario in which a legitimate and fully-resourced company could have gotten this contract in a similar fashion and done a better job with it. The process would have still been a problem, but at least the result was okay. Here we had both a bad process and a bad outcome, and both of those need to be investigated. They also need to be hung around Greg Abbott’s neck from now until November of 2022.

Put a pause on that reopening

Jun 27th, 2020
by Charles Kuffner.
2 comments

At this point, we had no other choice.

Gov. Greg Abbott on Friday took his most drastic action yet to respond to the post-reopening coronavirus surge in Texas, shutting bars back down and scaling back restaurant capacity to 50%.

He also shut down river-rafting trips and banned outdoor gatherings of over 100 people unless local officials approve.

“At this time, it is clear that the rise in cases is largely driven by certain types of activities, including Texans congregating in bars,” Abbott said in a news release. “The actions in this executive order are essential to our mission to swiftly contain this virus and protect public health.”

Bars most close at noon Friday, and the reduction in restaurant capacity takes effect Monday. Before Abbott’s announcement Friday, bars were able to operate at 50% capacity and restaurants at 75% capacity.

As for outdoor gatherings, Abbott’s decision Friday represents his second adjustment in that category this week. Abbott on Tuesday gave local governments the choice to place restrictions on outdoor gatherings of over 100 people after previously setting the threshold at over 500 people. Now outdoor gatherings of over 100 people are prohibited unless local officials explicitly approve of them.

Abbott’s actions Friday were his first significant moves to reverse the reopening process that he has led since late April. He said Monday that shutting down the state again is a last resort, but the situation has been worsening quickly.

I can’t emphasize enough that none of this had to happen. Greg Abbott laid out four metrics for reopening when he first lifted the statewide stay-at-home order: Declining daily case rates, positive test percentages below a certain level (I forget what exactly, maybe seven percent), three thousand contact tracers hired by the state, and sufficient hospital capacity. None of the first three were ever met, even at the beginning, and the predictable result is that now the fourth one is no longer being met. We could have driven the reopening by the metrics, instead of saying “on this date we’ll roll back these things and allow these things to resume”, but we didn’t. Greg Abbott made that decision. What is happening now is on him.

And so, here in Harris County, where our leaders’ efforts to take this pandemic seriously were entirely undercut by Greg Abbott, we are paying the price.

Harris County Judge Lina Hidalgo on Friday moved the county to the worst threat level, calling for a return to the stay-at-home conditions of March and April, as COVID-19 hospitalizations continue to spike.

She also banned outdoor gatherings of more than 100 people in unincorporated Harris County, while urging mayors to do the same in their cities.

Hidalgo described in dire terms the danger the pandemic currently poses, and said the county is at greater risk than at any other time since the outbreak began here in March.

“Today we find ourselves careening toward a catastrophic and unsustainable situation,” Hidalgo said. “Our current hospitalization rate is on pace to overwhelm the hospitals in the near future.”

Her remarks were a rebuke of Gov. Greg Abbott’s phased reopening strategy, which she said allowed Texans to resume normal life before they were safe. They also contradicted the rosy picture Texas Medical Center executives painted a day earlier of the system’s ICU capacity.

Hidalgo unsuccessfully lobbied the governor this week for the power to issue more restrictions, her office confirmed. Abbott’s refusal to let local officials again issue mandatory stay-at-home orders leaves Harris County “with one hand tied behind our back,” she said.

[…]

Though she lacks the power to require compliance, Hidalgo implored all county residents to follow the same rules as her stay-at-home order in March and April. That means residents should stay home except for essential errands and appointments, work from home if possible, wear a mask in public and otherwise avoid contact with other people.

Only a collective change in behavior can reverse the accelerating trend of COVID here, Hidalgo said. The alternative, she warned, is grim.

“If we don’t act now, we’ll be in a crisis,” she said. “If we don’t stay home now, we’ll have to stay home when there are images of hospital beds in hallways.”

Hidalgo and Dr. Umair Shah, the county’s health director, offered no concrete timeline for how long restrictions would be needed. The county judge noted that in some other states, lockdowns of up to three months were needed to bring the virus under control.

A tripling of cases and hospitalizations since Memorial Day have placed intense pressure on state and local leaders to act. With Abbott’s blessing, Hidalgo and other local leaders have issued mandatory mask orders since last week, mandating businesses to require their customers wear facial coverings.

The governor effectively gutted Hidalgo’s original order requiring residents to wear masks at the end of April by preventing any punishments from being levied against violators. Enforcement never was the point, Hidalgo said Friday, but she blamed the governor for signaling to residents that mask-wearing was unimportant.

See here for the background. We can’t know what shape Harris County would be in now if Judge Hidalgo had been allowed to make her own decisions instead of being overruled by Abbott. But it’s hard to say we’d be any worse off than we are now.

Of course, some people still think it’s all sunshine and puppies up in here.

Texas Lt. Gov. Dan Patrick went on national television to declare Texas is not running out of intensive care hospital beds and to assure viewers that the state is “not stepping backward” in re-opening businesses.

Speaking on Fox News Channel on Thursday night, Patrick acknowledged new COVID-19 cases are increasing in Texas, but assured viewers it was expected.

“We have seen a spike in cases. We expected that,” Patrick said pointing to increased testing. “Our hospitalizations are up, but here’s the good news, the good news is we’re not seeing it translate to the ICU unit or into fatalities.”

You can read the rest if you want, but really, what you need to do is CLAP LOUDER!

There is one piece of good news:

The Trump administration reversed itself and extended support for testing sites in Texas on Friday.

The extension followed a public outcry after TPM revealed on Tuesday that federal help was set to end on June 30.

Health and Human Services Assistant Secretary Brett Giroir said in a statement that his agency would support five testing sites in Texas for two weeks longer than initially planned.

Sens. Ted Cruz (R-TX) and John Cornyn (R-TX) sent a letter to HHS Secretary Alex Azar on Thursday requesting an extension of support for the free, drive-through testing sites.

Local officials in Texas have spent weeks clamoring for the sites to be extended. The move comes as cases and hospitalizations in the state have skyrocketed, and as Gov. Greg Abbott (R) has paused the state’s reopening.

“Federal public health officials have been in continuous contact with our public health leaders in Texas, and after receiving yesterday’s request for an extension, have agreed to extend support for five Community-Based Testing Sites in Texas,” Giroir said in a statement. “We will continue to closely monitor COVID-19 diagnoses and assess the need for further federal support of these sites as we approach the extension date.”

See here for the background. It’s two weeks’ worth of good news, which isn’t enough but is better than nothing. Now let’s extend that out to infinity, or whenever we don’t need testing at scale, whichever comes first.

One more thing, just to hammer home the “it didn’t have to be this way” point:

Texas is also a wee bit larger than Taiwan, with less density and public transportation. They’re already playing baseball in Taiwan, have been for a few weeks now. I’m just saying.

Hotze versus contact tracing

Jun 18th, 2020
by Charles Kuffner.
1 comment

We should have expected this.

Conservative firebrand Steven Hotze has launched another lawsuit challenging Gov. Greg Abbott’s coronavirus response, joined by current and former lawmakers and several hundred business owners who argue the state’s contact tracing program infringes on their privacy and ability to make a living.

The civil action filed Monday in federal court takes on the disparate operating capacities the governor mandated in his “COVID-19 lottery,” claiming Abbott’s actions have limited restaurants and bars with 25 or 50 percent limits, while bicycle shops, liquor stores, pool cleaners and supermarkets are running at full tilt.

[…]

The lawsuit by Hotze includes nearly 1,500 names. Most are small business owners, but topping the list are state Rep. Bill Zedler, R-Arlington, former Republican state representatives Gary Elkins, of Houston, Molly White, of Bell County, Rick Green, of Hays County, and former party chair Cathie Adams, of Collin County.

The suit argues that Texas’ $295 million contract tracing program — aimed at tracking down all people exposed to an infected person — violates the first amendment, privacy, due process and equal protection provisions. Such tracking amounts to an illegal, warrantless search, the suit says. While tracing back contacts is supposed to be voluntary, it is enforced through local health departments based on a presumption of guilt for all people in proximity to a sick person, according to the lawsuit. It requires people to turn over names, call in with their temperature readings and assumes a person has COVID-19 unless they can prove otherwise, Woodfill said.

Woodfill said he believes this is the first federal challenge to contact tracing. He hopes it will set the tone for “how we as a government and as a people will deal with diseases that we don’t have a vaccine for yet.”

Yes, of course that’s Jared Woodfill, joined at the hip as ever with Hotze on these things. We had the original lawsuit against Harris County, over the stay-at-home order. That was then followed by the lawsuit against Abbott and Paxton over the statewide stay-at-home order, for which there is now an emergency petition before the State Supreme Court. Another lawsuit against Harris County was filed over Judge Hidalgo’s face mask order, a subject that may soon be relevant again. That one too has a motion before the Supreme Court for an emergency ruling. I am not aware of any rulings in any of these lawsuits, but sooner or later something will happen. Abbott’s contact tracing plan is full of problems, and as I’ve said before there are legitimate questions to be raised about Abbott’s various orders during this pandemic. For sure, the Lege should try to clarify matters in 2021. I would just greatly prefer to have these legitimate questions get asked by legitimate people, not con men and grifters. That’s not the world we live in, unfortunately.

All this got me to thinking: Why doesn’t Hotze announce that he’s running for Governor in 2022? He clearly has some strong opinions about the way the state is supposed to be run, and in doing so he has some stark disagreements with Greg Abbott. Just as clearly, he has some support among the wingnut fringe for those differing opinions. It seems unlikely he could win – among other things, Abbott has a gazillion dollars in his campaign treasury – but he could force a dialogue on his issues, and very likely could bring some real pressure on Abbott. He’s also the kind of preening egotist who’d think he’s got The People behind him. I’m just idly speculating, and maybe trying to stir up some trouble. I can’t help but think that this is the biggest public example of Republican-on-Republican rhetorical violence since Carole Keeton Strayhorn was Rick Perry’s main nemesis. (I’m not counting Kay Bailey Hutchison’s primary against Perry in 2010, since she barely showed up for it.) I don’t really think this is where Hotze is going, but if he does do something like this, would you be surprised? At this point, I would not be.

Threat level orange

Jun 13th, 2020
by Charles Kuffner.
1 comment

Not great.

A large, ongoing outbreak of COVID-19 places the Houston area on the second-highest of four public threat levels unveiled by Harris County Judge Lina Hidalgo on Thursday.

If troubling trends continue, including an increase in coronavirus cases and hospitalizations, the county health department again would recommend residents stay at home except for essential errands, such as buying groceries and medicine, she said.

Without criticizing Gov. Greg Abbott directly, she said the reopening of businesses he permitted to begin May 1 happened too quickly, leaving the Houston area at risk of an outbreak hospitals are unable to handle.

“I want the reopening to be successful. I want the economy to be resilient,” Hidalgo said. “But I am growing increasingly concerned that we may be at the precipice of a disaster.”

The county judge said she wanted to create an easy-to-understand chart for the public to replace a series of lengthy advisories and orders her administration has issued to date.

The county currently is at Level 2 of the color-coded chart produced by the county health department, with Level 1 being the most severe.

Level 2 is defined by ongoing transmission of the virus, with testing and contact tracing likely to meet demand. It states that residents should avoid unnecessary contact with others, avoid crowds and visit only businesses that are following public health guidelines.

Coronavirus cases in the Houston area have increased steadily since Memorial Day weekend, and COVID-19 hospitalizations reached an all-time high last week. Harris County had 9,296 active cases and 267 deaths as of Thursday.

[…]

Hospitals in the 25-county Houston region were using 88 percent of their ICU capacity as of Wednesday, and the system has never exceeded 100 percent. City of Houston health authority Dr. David Persse, however, said the situation at individual facilities is more dire. He expressed particular concern about the two public hospitals in the Harris Health System, Lyndon B. Johnson and Ben Taub.

During the county’s stay-at-home period, local ICU bed usage often was below 80 percent.

See here and here for some background. You can find the threat level system here. To put that latter statistic into some context:

But don’t worry, Greg Abbott is concerned but not alarmed.

Two weeks ago, Gov. Greg Abbott visited Amarillo to declare victory over a coronavirus outbreak that had wreaked havoc on the Panhandle.

Showcasing dwindling caseloads and a stable supply of hospital beds, he said the region’s success was indicative of a state moving forward amid a containable pandemic.

“Amarillo has turned a corner on its pathway toward a positive, effective resolution of this particular hotspot,” Abbott remarked, applauding local officials and the “surge” teams of medical and military staffers that have become a hallmark of his reopening playbook.

But as one problem subsided, others newly emerged. Cases in Texas have since ballooned to record highs, and hospitals in Houston, San Antonio and other major cities are filling once more with COVID-19 patients. On Friday, as Abbott allowed restaurants to open at near-full capacity, the public health nightmare seemed to only be growing.

The governor, though — one of the first to relax his state’s stay-at-home order — is pushing ahead. “Concerned but not alarmed” was how he and his surrogates put it this week, even as fellow governors in Oregon and Utah pumped the brakes on their reopenings amid rising caseloads.

“This was to be expected,” said Abbott, a Republican, in a television interview on Wednesday. “Many of these cases we’re seeing have been in the aftermath of the Memorial Day weekend, and some are the early part of when these protests began.”

[…]

John Wittman, a spokesman for Abbott, said responsibility ultimately lies with the public.

“Texans have done a good job so far, but the reality is people need to stay vigilant,” he said. “Summer is here and everyone wants to go to the pool, but COVID has not left the state. People need to social distance, they need to wear masks.”

Seems like a lot to ask of the public when the consistent message from its leaders is “we’re reopening, it’s safe to go to bars and waterparks and gyms and whatever else again”. Greg Abbott listed four key metrics. We only ever met one, and that’s hospital capacity. We’re still short on contact tracers, which may not matter anyway since a significant portion of the population won’t cooperate with them anyway. As of a month ago, we were near the bottom of state testing per capita; I can’t find any more recent numbers than that. If Abbott ever does get alarmed, we’re well and truly screwed. The Trib has more.

Anti-vaxxers gonna anti-vaxx

Jun 8th, 2020
by Charles Kuffner.
Comments are off for this post

Every step of the way, they are an obstacle to public health.

The Texas group that lobbies against vaccine mandates is now launching a campaign against COVID-19 contact tracing, the public health measure used for decades around the world to contain disease spread.

Texans for Vaccine Choice this week called on its members to contact Gov. Greg Abbott and let him know they “do not wish to be monitored or surveilled for any reason” in response to a new state program hiring and training workers to identify people who’ve come into close contact with those who recently tested positive for the coronavirus. Such people are then asked to quarantine until testing shows they don’t have the disease.

“The government should stop thinking its job is to keep everyone healthy and instead focus on protecting our rights,” says a post on the organization’s website. “We here at TFVC will remain vigilant as our government expands greatly and the threats to our members grow.”

The campaign drew an immediate rebuke from Dr. Peter Hotez, the Baylor College of Medicine infectious disease specialist who has led public health’s fight against the anti-vaccine movement, which he holds responsible for the resurgence of vaccine-preventable diseases such as measles and whooping cough.

Thanks to the movement’s efforts, some 60,000 Texas parents currently obtain non-medical exemptions for school vaccines, some 25 times higher than 2003, the first year such exemptions were allowed. A 2018 study by Hotez found Houston and three other Texas cities rank among the 15 metropolitan “Shotspots” of such exemptions.

“Awful to see the #antivax lobby in Texas now going the extra measure to halt #COVID-19 prevention,” Hotez tweeted Tuesday in reply to a Texans for Vaccine Choice tweet alerting people to the campaign. “In the name of fake ‘health freedoms’ slogans, they aspire to land thousands of Texans in our hospitals and ICUs.”

John Wittman, a spokesman for Abbott, noted that a contact tracing program was part of the guidelines laid out by President Donald Trump in order to reopen the state and has been used in Texas and the country for decades. He said the program is “completely voluntary” and that the state health department has “taken steps to ensure it protects individuals’ liberty and privacy.”

There are certainly questions to be raised about the state’s contact tracing plan, though those questions should mostly be about competence and cronyism. I can sort of see the rationale behind the anti-vaxx movement, if I squint and do some deep-breathing exercises. The point of contact tracing is to find and notify people who may have come into contact with a person who has tested positive for COVID-19. I’m really hard-pressed to see what the problem is with that, beyond the usual tinfoil-hat paranoia about RFID chips, UPC codes, and our precious bodily fluids. We already know we have a long fight ahead over an eventual coronavirus vaccine, which is now a partisan issue as well as another thing for these people to froth about. The rest of us need to recognize this for what it is, which is a direct threat to our health. What are you going to do about that, Governor?

So how’s that reopening going?

Jun 7th, 2020
by Charles Kuffner.
11 comments

Well, there’s more of it.

Gov. Greg Abbott announced his third phase Wednesday of reopening Texas businesses during the coronavirus pandemic, allowing virtually all of them to operate at 50% capacity.

That is effective immediately, and there are “very limited exceptions,” Abbott’s office said.

Restaurants were already permitted to be open at 50% capacity. Abbott is allowing them to immediately increase their table size from six people to 10, and on June 12, they can ramp up their capacities to 75%.

Abbott’s latest order also brings news for professional and college sports that are played outdoors, letting the former shift from 25% capacity to 50% capacity at their stadiums and allowing the latter to resume for the first time, also at 50%.

“The people of Texas continue to prove that we can safely and responsibly open our state for business while containing COVID-19 and keeping our state safe,” Abbott said in a statement.

Sounds lovely. However:

The announcement came as the state sees record numbers of new daily cases of COVID-19. On Wednesday, the seven-day average for new daily cases hit 1,466, up from 1,280 in mid-May, a Houston Chronicle data analysis shows.

Abbott said nearly half of all new cases are isolated at jails and prisons, meatpacking plants and nursing homes, environments where he says outbreaks can be contained as the reopening progresses. The state has moved to increase testing at many of those locations, though testing as a whole remains stagnant, well below the governor’s goal of 30,000 tests per day. The state has averaged about 23,000 tests per day for the past three weeks.

Hospitalizations, another key measure, were down on Wednesday but have been rising steadily in the past week. They were still well below statewide capacity.

The state reported 23 COVID-19 deaths per day over the past week, down from nearly 40 in mid-May.

Abbott has said he would watch deaths and hospitalizations closely as he reopens the Texas economy.

Still, public health officials have said the state is at best plateauing, with new cases neither falling nor surging. And they have worried that the Memorial Day holiday and protests over police brutality, which have drawn tens of thousands to the street in major Texas cities, may also hasten the spread of the disease.

[…]

Dr. Peter Hotez, an infectious disease expert at Baylor College, warned last month that the state is moving too quickly.

“I understand the importance of opening up the economy,” he told the Chronicle. “The worry I have is that we haven’t put in place a public health system — the testing, the contact tracing — that’s commensurate to sustain the economy.”

I’ll get to the contact tracing in a minute, but first let’s review that hospitalization metric, because it’s always been the one metric of four that the state has actually met. But it too is going in the wrong direction.

The state reported 1,487 people hospitalized for COVID-19 on Wednesday, the lowest since April. But that figure did not include about 300 patients in the Houston area, who were omitted because of a software glitch, according to the Southeast Texas Regional Advisory Council, which collects the totals and sends them to the state.

With those patients included, the number on Wednesday was likely around 1,800, just shy of the state’s peak in early May.

Hospitalization data are one of the key measures that Abbott has said he’s watching as he allows more of the state to reopen. Virtually all businesses in the state can now operate at 50 percent of their maximum occupancy, and late next week restaurants will be able to move to 75 percent.

Lori Upton, the advisory council’s vice president of disaster preparedness and response, said the state informed it on Wednesday that a nationwide software upgrade had caused the error, lowering the preliminary count. A correction will take time because the data has to be recounted manually, Upton said.

She said technical issues are not common.

The governor’s spokesman did not respond to questions about whether the governor knew about the inaccuracy. Abbott, a Republican, has repeatedly advised against using single-day data points, explaining that weekly averages better capture trends over time.

On Friday, the seven-day average was 1,729, the highest number since the state began publishing data on hospitalizations. It has been increasing since May 27.

[…]

Though hospitalizations are up, average daily hospital admissions have been flat or slightly down over the past week, according to state data compiled by the nonprofit Texas 2036. Lauren Ancel Myer, a professor of integrative biology at the University of Texas at Austin, said that would be a positive indicator.

Myers said daily admissions in Central Texas, though, where her research is focused, have been up slightly in recent days.

“It would not be surprising at this point if we are beginning to see that the relaxation of social distancing measures, if that has actually increased the spread of the virus and has led to more patients needing hospital care,” she said.

So what happens if we do get close to the occupancy limits we have set? Well, maybe contact tracing can help with that. Oh, wait.

As Texas moves forward with a new phase of Gov. Greg Abbott’s plan for reopening businesses, the state has fallen more than 25% short of its goal for a workforce of disease detectives that experts say are crucial for tracking the spread of the new coronavirus.

One of Abbott’s reopening metrics for June 1 called for up to 4,000 Texas contact tracers, who work to identify people with possible exposure to the coronavirus and call them to get tested and self-quarantine.

But Texas officials said Thursday there were roughly 2,900 contact tracers working around the state. Of those, some 1,140 are working for the Texas Department of State Health Services, 1,170 are working for local health departments or their nonprofit and university partners, and about 600 are working for a company recently hired by the state.

State officials downplayed the importance of meeting the initial goal despite the public health agency’s statements last month assuring that health departments were in a “phase of hiring that will get us up to 4,000 in the coming weeks.”

The 4,000-person figure was an estimate taken from a national association of public health officials that was determined by the state’s population, Texas Department of State Health Services spokesman Chris Van Deusen said.

“Texas has had significantly fewer cases per capita than the national average, and we want to match the number of contact tracers to the actual workload,” Van Deusen said in an email, adding that the state has enough personnel to contact all new cases in its jurisdiction.

But other groups have suggested that Texas needs a far higher number of contact tracers. One model from George Washington University put the number at more than 8,000.

And it turns out that the firm the state gave a $295 million contract to do contact tracing is sketchy.

More than a dozen Republican legislators are bucking Gov. Greg Abbott by calling for termination of a controversial $295 million coronavirus-related contract that was hastily awarded to a company whose CEO falsely claimed he had a Ph.D.

At least two top Democrats — including the party’s leader in the Texas House of Representatives — are also criticizing the deal with MTX Group Inc., saying the state needs to demonstrate the company is up to the vital job of tracking down people who have been exposed to COVID-19, or else it should pull the plug.

The bipartisan criticism comes as the agency that oversees the contract, the Texas Department of State Health Services, acknowledges that MTX “mistakenly uploaded” job training documents to its contact tracers that they were never supposed to get, a move some lawmakers say potentially raises privacy concerns.

Another potential privacy issue: MTX workers are using their own computers and personal email addresses, fueling worries — unwarranted worries, the state says — that private medical information about the people they investigate could be inadvertently divulged.

State Rep. Steve Toth, R-Conroe, like many conservative Republicans, already had privacy concerns about COVID-19 contact tracing before MTX got the job. But he said when he learned that MTX CEO Das Nobel had falsely claimed on his online LinkedIn bio that he had a doctorate from Colorado Technical University, he moved into the end-this-now camp even as Abbott staunchly defends the emergency contract.

“Up until that point, I was like, OK, I’m not good with this, but let’s just chill and find out more,” Toth said. “That pushed me over the edge.”

I mean, look. The overall numbers are still fairly modest, and the hospitals have done well so far. Treatment has improved as we have learned more, so people are spending less time and need less intensive therapies in hospitals. It is true that a large percentage of infections are in limited locations, and the risks of various activities, mostly outdoor activities, is understood to be fairly small. My point is this: The state hasn’t met its own metrics, contact tracing is a mess, and as far as I can tell there’s no plan except “clap harder!” to deal with any significant upticks in the infection rate. If I felt better about there being a plan for if and when the curve started going up again, I’d have fewer complaints. I just don’t know what we are going to do if things do not get better but do get worse. I admit, maybe that won’t happen. But that kind of hope appears to be all we have right now. I’m worried about it because I don’t think our state leaders are worried enough about it, never mind the dumpster fire in Washington. So yeah, I’ll hope for the best. What else can I do right now?

And so reopening begins

Apr 28th, 2020
by Charles Kuffner.
3 comments

I have questions.

Gov. Greg Abbott said Monday that he will let the state’s stay-at-home order expire Thursday as scheduled and allow businesses to begin reopening in phases the next day, the latest ramp-up in his push to restart the Texas economy amid the coronavirus pandemic.

First to open Friday: retail stores, restaurants, movie theaters and malls. But they will only be allowed to operate at 25% capacity. Museums and libraries will also be allowed to open at 25% capacity, but hands-on exhibits must remain closed.

Abbott said a second phase of business reopenings could come as soon as May 18 — as long as the state sees “two weeks of data to confirm no flare-up of COVID-19.” That second phase would allow business to expand their occupancy to 50%, according to the governor.

Abbott made the announcement during a news conference at the Texas Capitol, which he began by saying he would let the stay-at-home order expire because it “has done its job to slow the growth of COVID-19.” While the spread of the virus in Texas has slowed down throughout April, the number of cases is still increasing day to day, and it is unclear if the state has yet seen its peak.

“Now it’s time to set a new course, a course that responsibly opens up business in Texas,” Abbott said, flanked by Lt. Gov. Dan Patrick and Texas House Speaker Dennis Bonnen. “Just as we united as one state to slow COVID-19, we must also come together to begin rebuilding the lives and the livelihoods of our fellow Texans.”

Abbott said his new order “supersedes all local orders” saying those businesses must remain closed. He also said his order overrules any local government that wants to impose a fine or penalty for not wearing a mask — something the latest statewide rules encourage but do not mandate.

Speaking shortly after Abbott in Houston, the city’s mayor, Sylvester Turner, told reporters that Abbott’s new order “pretty much will take these measures, the ability to [issue] stay-at-home orders and things of that nature, out of our hands locally.” He said he hoped Abbott’s plan works but offered a “cautionary note,” pointing out that there is still no vaccine and statistics show the “virus is still here,” even as local measures have slowed it down.

Abbott stressed that his order “gives permission to reopen, not a requirement,” and businesses can stay shuttered if they would like.

At the same time, Abbott said he is holding off on reopening certain businesses for the time, including barbershops, hair salons, bars and gyms. He said he hopes those businesses can open “on or no later than mid-May.”

[…]

Abbott mostly focused Monday on contact tracing, or the practice of tracking down and isolating all the people someone who tested positive for the virus has come into contact with. Abbott said Texas is already in the second phase of its contact tracing plan, adding 1,000 tracers on top of the existing 1,100 and launching a statewide app and call center to improve the process.

Abbott continued to talk of a coming increase in testing and said the state soon would “easily exceed our goal of 25,000 tests per day.” The state has been adding an average about 14,000 tests per day over the past week, according to figures from the Texas Department of State Health Services. Still, the total number of tests done as of Monday — 290,517 — remained about 1% of Texas’ nearly 29 million people.

See here for the background, and here for the plan, such as it is. It’s full of guidelines for various businesses and customers and nursing homes and the like, and short on details about things like how we’re going to achieve the testing goal. If you haven’t yet started wearing a face mask you don’t have to, though you really should and in some places you won’t have a choice regardless of what Abbott says.

I said I have questions, so here are a few:

– How many businesses will consider it worth the bother to reopen at 25% capacity?
– What does “confirm no flare-up of COVID-19” mean? As the story notes, the daily number of cases is continuing to rise. If two weeks from now that is still the case, but the rate of the daily increase hasn’t gone up, is that a success under the Abbott plan?
– What happens if there’s a local “flare up”, like say at another meat processing facility, or just in some random part of the state? If Montgomery County has seen an uptick in cases, do they get to re-impose a shutdown order?
– When should we expect to see that statewide app? Will it require some minimum number of people to download and install it in order to work? What metrics will there be for it – number of app downloads, number of people traced, number of infections mapped out, etc? What happens if we fail to meet those metrics?
– What medical experts advised on this? Because clearly not all medical experts are in agreement with it.

I don’t know the answer to these questions. I doubt Greg Abbott knows the answer to most of them. As I said before, the word that comes to mind for this is “half-baked”. Maybe everything will be fine, maybe we’re just easing up on less-risky behavior, maybe that testing and contact tracing regimen will be more robust than I expect, maybe people will continue to take social distancing seriously enough to keep a lid on things. I hope everything does go well. I’d surely like to start going places and doing things again. I’m just concerned that we barely have a Plan A, let alone a Plan B. What will we do if this doesn’t go the way we hope? The Current, the Press, the Rivard Report, and the Chron have more.