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Harris County Public Health Authority

Back to school

How’d it go for you and your kids?

On a normal first day of school, Texas children would wake up early to cram into school buses, eager to huddle and chat with their friends in the hallways before streaming toward their classrooms.

On Tuesday, as many of the state’s biggest urban and suburban districts return for their first day of in-person instruction, there is anxiety mingled with that excitement. Many parents will not be allowed to walk their kindergarteners inside for their first day. Teenagers will be shooed away if they congregate around their lockers. Meals will be grab-and-go, often eaten in classrooms instead of raucous cafeterias. Students and teachers will wear masks, trying to stay as far apart from one another as possible even as they come together for the first time in months.

Many kids will not be entering their schools at all. Some of the state’s biggest districts, including Houston and Dallas independent school districts, will not open their classrooms for in-person learning until late September or October, and they may even ask the state for more time if the virus isn’t under control.

In-person instruction will look very different from campus to campus. Some districts will bring students back in phases, starting with those who most need in-person education, like students with disabilities or those learning English. In San Antonio’s North East ISD, no more than five students will be in each classroom this week. Other districts are welcoming back all students who opted for in-person instruction at the same time.

Only about half of Seguin ISD’s students are expected to head into classrooms Tuesday morning for the first day of in-person instruction. They will walk past thermal scanners, which can measure the body temperature of about 30 people at a time and detect fevers that may be signs of illness. Middle and high school students will sit in desks spread apart, in many cases less than 6 feet with dividers, and younger students will be separated by dividers at large round tables.

Most teachers will be simultaneously instructing 12 to 16 students in their classrooms and more at home tuning in from cellphones or laptops. Some teachers will sit in empty classrooms and broadcast lessons to 20 or 30 students. A small number who have health conditions or young children received waivers to teach virtually from their homes.

Here’s the local view.

Students in Klein and about nine districts throughout the region will get their real first taste of the new learning environment on Tuesday as those districts welcome back those who opted to come to school rather than attend online. Among them are Cypress-Fairbanks, Katy, Conroe, Spring Branch, La Porte, Magnolia and Santa Fe ISDs.

It marks the biggest return of students to school campuses in six months, after schools were closed in mid-March to help slow the spread of COVID-19. Already, students in Lamar CISD and Humble, Alvin, Dickinson, Galveston and Barbers Hill ISDs have brought some of their students back in recent weeks.

The districts are forging ahead with plans to reopen campuses despite warnings from regional health authorities and some local leaders who say it still is too early. Harris County Judge Lina Hidalgo and Public Health Executive Director Umair Shah recommended in August that schools remain closed until there are fewer cases of COVID-19 and less community spread. The two set benchmarks for schools to begin reopening, but with current statistics, it would take weeks to reach them.

Hidalgo and Shah only can offer recommendations, after Gov. Greg Abbott said local government officials do not have the legal authority to preemptively close campuses. Instead, he said, those decisions should be left to school districts. In some Houston-area districts, school boards, parents and some educators have argued that the benefits of face-to-face instruction, especially after such a long hiatus, outweigh potential health risks.

“We can provide a schooling online, but we can’t provide an education online,” Cypress-Fairbanks ISD Superintendent Mark Henry said at a July board meeting.

Others have opted to keep their students learning remotely for the foreseeable future, including Fort Bend and Alief ISDs. In Houston ISD, the state’s largest district, students will return Tuesday to online-only classes, which are scheduled to remain in place until mid-October.

District officials estimate that about 18,000 students still lack the computer or internet access needed for online classes. As a result, HISD is directing those students to 36 “learning centers” with adult supervision and available technology. HISD officials said they are not publicizing the learning center locations.

“It just can’t be everyone showing up,” HISD Interim Superintendent Grenita Lathan said. “It’s truly assigned locations for students and staff.”

[…]

For those that already have opened classrooms, teachers and students still are adapting.

In Humble ISD, middle and high school students are coming into the buildings in alternating groups, with an A group coming on some days and a B group on others.

Superintendent Elizabeth Celania-Fagen said she has been surprised the elementary schoolers have not had as many issues with face masks and social distancing as some had feared.

“We’re starting to get our arms around it pretty well,” Fagen said. “Every day there are new metrics to monitor, and we hope we can get to a place for (more) in person in near future.”

For students at Klein ISD’s Mahaffey Elementary who chose in-person instruction, last Wednesday served as a crash course for their new school realities.

Staff practiced funneling students through entrances assigned by grade rather than the main doors in the front. They showed students how to keep their distance in hallways and spent class periods juggling between in-person students and those learning remotely on Zoom calls. They adjusted their cameras, helped parents troubleshoot technology problems and made sure the kids in their classrooms knew the new procedures.

It was a strange day here, as my girls started with remote learning. We’re used to that, in that we had done it before, but it was still strange to just transition from “no school” to “distance learning school”. Didn’t have that usual “first day of school” feel, you know? There were some connection issues on the HISD hub that affected Olivia’s school, but students were redirected to an alternate site that seemed to work, so no big deal. Ask me again in a week how it’s going.

For the schools that are reopening for in person instruction, I sure hope it all goes well. I hope the mask-wearing and social distancing and other protocols that are being adopted to (hopefully) keep virus spread to a minimum works as planned, not just for them but for the rest of us, who will be in the same position in six weeks. Unless it doesn’t go well, of course, in which case they’ll be in the same position as us. I absolutely want everyone to get back to school. I also absolutely want everyone to literally survive the year, with no adverse health effects lingering on. I don’t know that we can do both of those things just yet. I’m glad it’s not my kids’ schools that are the guinea pigs for that experiment, and I sincerely hope that experiment is a ringing success. I figure we’ll know, more or less, by the time it’s our turn to go back.

Some superintendents disagree about school opening delays

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.

Time for another COVID roundup

Let’s start with some good news, which comes wrapped in a warning.

The number of coronavirus patients crowding hospital wards in the Houston area is now in its sixth week of steady decline, a welcome reversal of the virus’ alarming surge in June and July.

The headcount of COVID-19 patients has fallen by half since its mid-July peak in hospitals affiliated with the seven systems based in the Texas Medical Center. And the number of intensive care patients at those facilities has dropped by a third.

The subsiding wave has merely shifted civic leaders’ concerns, however — and not only because hospital headcounts, new cases, and other metrics remain well above their levels before the spike.

Worried that Houstonians will invite another crisis by concluding it is safe to attend cookouts or crowd onto restaurant patios, public officials and medical leaders are stressing that the best measures of success are not empty intensive care beds but an absence of widespread infections.

“I do worry about people listening to this news and taking it the wrong way, saying, ‘Whew that’s over, now let’s go back to life as normal,’” said Dr. Esmaeil Porsa, CEO of Harris Health, the county’s public hospital district. “This is not the time.”

[…]

In every case, these metrics suggest the Houston region remains well short of containing the virus. The testing positivity rate, for instance, is about 15 percent in the city and county, and 10 percent among TMC institutions.

What about case counts? Harris County over the last week has averaged more than two and a half times as many daily cases as the 400 it would take to step down from Hidalgo’s top threat level. And the nine-county Houston region is averaging almost nine times as many new daily cases as the TMC goal of 200.

Another of Hidalgo’s metrics calls for the share of intensive care patients who have COVID-19 to not exceed 15 percent; the share of ICU patients in the county who have COVID-19 remains more than double that.

We’re headed in the right direction, but we’ve still got a long way to go. Stay home. Maintain social distancing. Wear a mask. Wash your hands.

And while case numbers may be coming down, fatality numbers are higher than we’ve counted.

Since the start of the COVID-19 pandemic in Texas, the state’s death toll from all causes has soared by thousands above historical averages — a sobering spike that experts say reveals the true toll of the disease.

Between the beginning of the local pandemic and the end of July, 95,000 deaths were reported in Texas, according to U.S. Centers for Disease Control data. Based on historical mortality records and predictive modeling, government epidemiologists would have expected to see about 82,500 deaths during that time.

The CDC attributed more than 7,100 deaths to COVID-19, but that leaves roughly 5,500 more than expected and with no identified tie to the pandemic. The CDC’s chief of mortality, Dr. Bob Anderson, said these “excess deaths” are likely from a range of pandemic-related problems, including misclassifications because doctors did not initially understand the many ways that COVID-19 affects the circulatory system and results in a stroke or a heart attack.

“It can cause all sorts of havoc in the body,” he said.

The CDC data offers an opaque but important estimate of how deadly the virus has been in Texas, which suffered from testing shortages for weeks as COVID-19 case counts climbed.

“It has shocked me to see people think that there’s overcounts of the COVID deaths, because I can’t even imagine that that’d be the case,” said Mark Hayward, a professor at the University of Texas who studies mortality trends. “The undercount is so dramatic.”

And there is a clear racial disparity in the undercounts. Between March and the end of July, Texas recorded more than 21,000 deaths of Latinos — more than 5,000 higher than epidemiologists predicted. Of those, about 2,100 were attributed to COVID-19. That leaves more than 3,000 deaths in excess of the expected number, many of them in border counties that lack resources for testing.

This is a phenomenon we’ve seen literally around the world. We’ve certainly known that it’s happening in Texas. The expert opinion is that we’ve already passed 200K deaths nationally, or about 25% more than the official count. If you could read one of the names of those 200K dead Americans every second, it would take you over 55 hours, nonstop, to read them all. Think about that for a minute. Or for 55 hours.

Also, too, we still suck at testing.

After plummeting for days, the number of COVID-19 tests reported in Texas suddenly jumped by 124,693 on Thursday, which state health officials said was a result of coding errors and a system upgrade.

Backlogs at a hospital lab and a commercial lab accounted for most of the tests, which could not be added to the state’s official tally until the coding errors had been fixed, said Lara Anton, spokesperson for the Texas Department of State Health Services.

Of the 124,000 tests reported on Thursday, approximately 95,000 were from a lab that served several hospitals, Anton said, adding that the lab sent files containing an error in one of the data fields, which DSHS’ electronic system could not read.

DSHS doesn’t know when the tests were actually conducted and is working with local health departments to find out, she said.

[…]

Whether because of human error, shifting benchmarks or bureaucratic changes, it’s not the first time that Texas officials have corrected their data since the beginning of the pandemic. Almost every major data point has come with caveats, sometimes blurring for days the big picture of the pandemic in Texas.

It is what it is. I don’t know what else to say.

Finally, the coin shortage is real, y’all.

Some retailers have started posting signs notifying customers that they might not be able to provide exact change for their purchases, and instead ask for them to pay with a credit or debit card or exact payment.

“It’s not like coins are not there,” said Venky Shankar, professor and director of research at the Center for Retailing Studies in Texas A&M University’s Mays Business School. The coins are just being used less as business has slowed and more people stay home.

Another hurdle for coin usage, Shankar said, is the fear that money could carry the novel coronavirus, even though experts don’t know definitively whether cash actually poses a threat.

In order to keep coins circulating, the U.S. Mint has asked people to pay with exact change. “We ask that the American public start spending their coins, depositing them, or exchanging them for currency at financial institutions or taking them to a coin redemption kiosk,” the mint said in a news release. A new task force — the U.S. Coin Task Force — has also been charged with determining how to reinvigorate the supply chain.

[…]

According to Shankar, roughly 45 to 50 percent of sales in smaller stores — places such as convenience stores — are made in cash. But big grocers such as H-E-B, Kroger and Walmart have also faced a shortage of coins.

In response to the shortage, some retailers and restaurants have started to pay or reward customers for their coins.

The U.S. Mint has also increased production from 1.2 billion coins in June to 1.35 billion coins per month for the rest of 2020, according to a Statista review.

But that doesn’t solve everything.

“That still will not unlock the coins that are already in the drawers and the banks,” Shankar said.

Laundromats, which rely heavily on coins to function, are among the businesses directly impacted by the coin shortage.

Yeah, that would suck if no one has any damn quarters. This is a problem all over, and offhand I have no idea what to do about it. I normally like paying for things in cash, but have barely used any since March. This is a teeny tiny reason for saying this, but we live in very strange times.

Harris County issues guidance for opening schools

They can’t issue mandates, so this will have to do.

Judge Lina Hidalgo

Harris County Judge Lina Hidalgo on Wednesday unveiled the county’s guidance for school reopenings, recommending based on a handful of COVID-19 metrics that schools offer only virtual instruction in the coming weeks until the virus is further curbed.

County officials are issuing the guidance as families and education officials continue to grapple with the idea of resuming in-person classes in the coming weeks, and after Gov. Greg Abbott barred local officials from ordering campus shutdowns to stem the spread of the coronavirus.

Under the non-binding guidance, Hidalgo and county health officials recommended that school districts offer only virtual instruction as long as Harris County, across a 14-day span, records more than 400 new COVID-19 cases per day, remains above a 5 percent test positivity rate or continues to devote more than 15 percent of hospital beds to COVID-19 patients.

School districts are advised to reopen with reduced capacity as those metrics improve and Harris County hospitals see a 14-day average flattening or decrease in their general and intensive care unit bed populations. At that point, school officials can consult with Harris County Public Health officials on their plans to reopen.

“We simply cannot responsibly reopen schools to in-person instruction right now,” Hidalgo said, acknowledging the frustration of parents, teachers and others. “But we can’t ignore this. We can’t tap our heels together and wish the current numbers away.”

Harris County officials are recommending schools remain closed longer than some other organizations.

[…]

County officials have not yet publicly released the rate of COVID-19 tests coming back positive, though Umair Shah, the director of Harris County’s public health department, announced Tuesday that the rate is between 15 and 16 percent. The Houston Health Department and Texas Medical Center on Monday reported positivity rates of 14.6 percent and 10.6 percent, respectively. The city’s 14-day average has continued to decline since peaking at nearly 30 percent in early July, but remains above the county roadmap’s 5 percent threshold.

Hidalgo and Shah lack the authority to order compliance with the roadmap before the school year begins. Abbott said July 31 that local school boards and state education officials can limit the reopening of buildings in the first eight weeks of the school year, but county officials may not shut down campuses preemptively.

The governor said local health authorities may shut down campuses in response to confirmed outbreaks in a building, but Texas Education Agency leaders said public school districts risk losing state funding if schools remain closed for longer than five days.

You know how I feel about this, so I’m mostly going to peace out here. Judge Hidalgo had ordered schools closed for in-person instruction until at least September 8, back when that was a thing the locals could do. HISD is beginning remote learning only on that date now, and even as a parent of two HISD students, I have no freaking idea when they will be ordered back to the classroom. You can see the Ready Harris roadmap here and the metrics for success here. Maybe if Greg Abbott took this stuff half as seriously as Judge Hidalgo does, we’d be in a better position to reopen schools with some confidence.

We don’t really know how many COVID-19 patients there are in Texas hospitals

For a variety of reasons, the data is hard to get a handle on.

Be like Hank, except inside

Texas is bracing for a pandemic that is projected to kill tens of thousands of people across the U.S., but health officials and state leaders are struggling to provide the public with timely updates on how many people are infected and how many hospital beds and ventilators are available for the critically ill.

Other states across the country have been providing coronavirus hospitalization figures for weeks. On Friday, Gov. Greg Abbott announced that 827 people have been hospitalized in Texas. But the true number of cases is likely far higher than the official tally due to a shortage of reliable tests and delays in delivering results, which can take up to 10 days.

Even with the limited number of confirmed positives, Harris County’s top epidemiologist says it feels like her team is constantly behind.

“It’s become overwhelming,” said Dr. Dana Beckham, director of the county’s Office of Science, Surveillance and Technology, which traces the steps of people who test positive for COVID-19 to determine how they got the disease and who they may have infected. “We’re always behind the eight ball.”

The county’s epidemiologists were pulling 12-to-16-hour days, seven days a week and they still couldn’t keep up, Beckham said. They brought in more workers – roping in other county government employees and hiring outside contractors – to prevent burnout and alleviate stress, tripling the number of people working in the unit to about 65.

It’s still not enough, she said.

As health officials scramble to mitigate the worst pandemic in generations, the level of detail released by Texas lags behind that of some counties and cities.

The Texas Department of State Health Services publishes a daily update of the official number of confirmed coronavirus cases — there were 5,330 statewide as of Saturday and 90 deaths. But the agency doesn’t routinely publish other key measurements that could show the potential for strain on Texas’ health care system in the coming weeks.

[…]

The 827 hospitalized coronavirus patients in Texas are confirmed COVID-19 cases — not suspected cases in which patients are exhibiting symptoms but have no test results, said Chris Van Deusen, a spokesman for DSHS.

Front-line health care workers in the Houston area have told the Houston Chronicle that many patients who should be tested and hospitalized are slipping through the cracks. They also worry that patients admitted with other conditions, such as a heart attack, who also are showing symptoms of the virus may not show up in overall counts.

Unconfirmed COVID-19 cases are likely taking up a significant number of hospital beds. According to the Southeast Texas Regional Advisory Committee, an organization tasked with tracking medical resources in Houston and the surrounding area, as of Thursday more than 700 patients with COVID-19 symptoms — which includes confirmed and suspected cases — had been hospitalized in Harris County alone.

More than 240 were being treated in intensive care units in the county, which has about 4.7 million residents. There were 480 patients on ventilators as of Thursday and 684 additional ventilators were available.

“Currently, we do not have any hospitals reporting that they are nearing capacity,” Darrell Pile, SETRAC’s chief executive officer, told the Chronicle in an email. “Available beds can actually rise if a hospital opens a closed wing, or opts to use beds in the recovery room or other specialty areas to care for inpatients.”

Van Deusen said the state health department had initially collected statistics on suspected cases from hospitals, but by Tuesday had only received reports on 629 patients statewide, raising questions about the accuracy of the state’s figures.

“Hospitalization reporting is a work in progress, and we’re definitely still refining the process,” Van Deusen said.

There’s too much to summarize, so I’d advise you to read that story and also this story about why the official reported numbers of COVID-19 cases in Texas is likely an order of magnitude too low. We’re not doing much testing, which means we can’t really track where the disease is trending, and we’re really just guessing about our hospital capacity and the potential for it to be overwhelmed. We can’t really tell if the local stay-at-home orders, which are now two weeks old, or the previous orders closing schools and canceling public events, which are coming up on four weeks’ duration, have had any effect on flattening the curve. The peak of the outbreak is likely still three or four weeks from now, so whatever the numbers are today, they are going to be a lot higher in the near future. That best-case IHME study Abbott is touting projects four to five thousand deaths in Texas; as of Sunday the official count was 127. That count is also likely low, for the same reasons – not everyone who needs it is getting tested, COVID-19 may be one of several causes of death but not the “official” one, etc – but the point is, we’re barely on the upswing of the curve. We have a lot of staying at home yet to do.

Younger people get coronavirus, too

Because that’s how viruses work.

More Houstonians younger than 60 are testing positive for the novel coronavirus than those who are most at risk of developing serious complications from the illness.

Of that number, middle-aged adults — those in their 40s and 50s — have garnered the brunt of the cases that have tested positive, according to a Houston Chronicle analysis.+

A review of 164 cases from March 4 through [March 23] in counties with confirmed diagnoses — Harris, Fort Bend, Montgomery, Brazoria, Galveston, Liberty and Chambers — show around 78 percent of COVID-19 cases in the greater Houston region are of children and adults under the age of 60. People older than that, who federal health authorities say they are more likely to require hospital care if infected, make up about 21 percent of those who have tested positive.

[…]

Even a handful of children in the Houston region tested positive for the novel coronavirus.+

Dr. Umair Shah, executive director of the Harris County Public Health, was aware of the trend of younger people contracting the novel coronavirus.

“People like me, who feel like they can go out and do everything — we, too, can test positive,” Shah said Tuesday morning at a news conference, where officials also announced a stay-at-home order.

“All of us have the potential of transmitting that to others,” he continued.

Maybe someone can tell Dan Patrick? It’s one thing for geezers like him to get sick and die, but people in their 40s and 50s aren’t Grandma and Grandpa, they’re Mom and Dad. And, as Dr. Shah notes, they’re all very capable of passing along the virus to whoever else they encounter, old and young. True, they’re less likely to die than old useless people like Dan Patrick, but 1) the chances are still greater than zero, and some people with zero risk factors have died from COVID-19; 2) plenty of younger folks have pre-existing respiratory issues and/or are immuno-compromised; 3) some people have had lasting after-effects of the disease; and 4) getting sick, and especially going to the hospital, can be very expensive. All of which to say, it’s better to not get sick. Which is what human beings with empathy and compassion, who are not sociopaths like Dan Patrick, are trying to accomplish with social distancing and stay-at-home requirements. I can’t believe I have to explain this, but here we are.

(Yeah, I drafted this last week, which now seems like a million years ago, and Dan Patrick has been blessedly quiet since then. He still needs to be raked over the coals at every opportunity for his hateful, nihilistic blatherings.)

Still trying to do something about the coronavirus risk in the jail

Time is extremely limited for this.

A federal judge Friday asked lawyers to hammer out a plan for releasing about 1,000 indigent inmates detained on bonds of $10,000 or less amid fear of a COVID-19 outbreak at the third largest jail in the country. The judge indicated she would take up the fate of another 3,400 people in the Harris County Jail awaiting trial on higher bonds next week.

The instructions by Chief U.S. District Judge Lee H. Rosenthal came in response to an emergency request Friday by the team of lawyers who challenged the county’s bail policies. They argued that thousands of poor defendants trapped in the jail simply because they couldn’t afford bail should be granted immediate bail hearings or be released.

The pleading laid a grave situation at the hands of a judge who has made many tough decisions in the criminal justice realm.

“A public health catastrophe of historic proportion looms in the Harris County Jail. Only this Court can avert it,” the motion says. “With every passing hour, the risk of disaster increases. All eyes turn to this Court in this dire moment.”

The bail lawsuit motion for a temporary restraining order and preliminary injunction seeks release of about half the jail’s population of nearly 8,000 if they cannot be afforded immediate bail hearings. This would mean thousands of people charged with nonviolent offenses would be allowed to await trial on bond outside the facility, as they would otherwise be able to do if they could post cash bond.

Other local officials, including the sheriff, state district judges and top county official have been tackling the potential public health threat from different angles over the past two weeks, seeking compassionate releases of medically vulnerable inmates, bonds for those accused of nonviolent offenses, or some cross-section of the two groups.

But early Friday lawyers from Civil Rights Corps, the Texas Civil Rights Project and pro bono counsel from Susman Godfrey, stepped in with a constitutional approach to the jail problem that could allow much more drastic cuts in the population than the compassionate release plans outlined by the sheriff and the county judge.

Rosenthal asked the lawyers for indigent defendants and attorneys for the sheriff and the county to assemble by Monday a list of thousands of people who might qualify for release based on their bond amounts, charges, criminal histories and risk factors. In addition, the judge indicated she would move swiftly on a subset of the indigent defendants who can’t pay their bond. She asked for confirmation that 1,000 or so people being held on bonds of up to $10,000 were not subject to other holds or detainers.

The sheriff and county officials told the judge that they had no objection to this first group being released if they fit the judge’s criteria. According to a lawyer for the plaintiffs, the only agency that opposed the release of those facing $10,000 bonds was the Texas Attorney General’s Office.

Sheriff Gonzalez had been working on this for the past week, trying to get individual judges to allow some inmates to be released, but the process was slow. County Judge Lina Hidalgo had been working on an executive order that would have released a larger number of inmates, but she shelved it after objections from the Attorney General’s office; you can read that story for the details. And I know, we’re all going to be murdered in our sleep by a rampaging horde of pot smokers and check kiters, but let’s do pause for a moment and consider what the alternative might be:

In another effort to address the issue, Harris Health System leaders on Friday sent a letter asking for the release of defendants with nonviolent offenses.

The county medical system’s president and CEO stressed that an outbreak in the Harris County Jail is not a matter of if, but when.

“The Harris County Jail and other large correctional facilities pose a real and immediate danger to the health of the community,” Esmaeil Porsa said. “An even limited outbreak of COVID-19 in the Harris County Jail has the potential to overwhelm our already overburdened hospital system. If this happened — and the likelihood is high — it could leave many vulnerable people in our community without access to care.”

Porsa urged the county to consider prioritizing inmates over 60 with pre-existing conditions such as cancer, diabetes, asthma and chronic pulmonary disease, heart disease and HIV. Jails are known to have higher concentrations of people in the high-risk group, he said.

He added that social distancing is nearly impossible, with dorm settings holding between 20 and 60 people in a close space. And quarantine is also unfeasible when inmates are booked in and out of the jail on a daily basis.

We could just let them all die, I suppose. I’m sure Dan Patrick would approve. I would rather not do that.

UPDATE: And now Greg Abbott is involved, and I’m confused.

As the first Harris County inmate tested positive for COVID-19 Sunday, Gov. Greg Abbott issued an executive order blocking any release of inmates from jails and prisons accused or convicted of violent crime.

“Releasing dangerous criminals from jails into the streets is not the right solution and doing so is now prohibited by law by this declaration,” Abbott said at an afternoon briefing.

The news comes as federal, state and local government officials continued to squabble over details of what a jail release would look like as they attempted to prevent a catastrophic outbreak among the approximately 8,000 people incarcerated at the downtown facility.

The governor was referencing Attorney General Ken Paxton’s motion to prevent Harris County from releasing 4,000 people awaiting trial on felonies, saying such a move would “allow dangerous criminals to roam freely and commit more crimes during the ongoing COVID-19 pandemic.”

“Protecting Texans is one of my highest priorities. It is vital that we maintain the integrity of our criminal justice system and continue to enforce state law during this pandemic,” Paxton said. “My office will not stand for any action that threatens the health and safety of law-abiding citizens.”

Hours earlier a federal judge convened an emergency hearing to address plans that plaintiffs in a federal civil rights case had hammered out over the weekend with lawyers for the sheriff and the county judge to release inmates accused of some nonviolent offense.

An official from Paxton’s office appeared telephonically at that hearing and said the AG planned to appeal an order by the federal judge to the 5th U.S. Circuit if it called for any blanket releases.

The judge set a hearing for Tuesday to address a possible appeal.

There wasn’t anything in the previous story about people accused or convicted of violent crimes, hence my confusion. I assume there are still plenty of people in the Harris County jail for misdemeanor charges, so it’s not at all clear to me what the extent of the dispute is. Maybe later versions of the story will make that more clear.

UPDATE: There’s now a more detailed version of the Chron story and also a Trib story, but this post is too long already. I’ll be back with more tomorrow.

The Houston healthcare community is preparing for COVID-19

I sure hope it’s enough.

With last week’s new certainty that the novel coronavirus is loose and being transmitted in Houston, the region’s medical providers are bracing for the current handful of known cases to blaze into an outbreak like nothing in modern memory.

“We had been saying, ‘It’s not a matter of if, it’s a matter of when,’” said Umair Shah, executive director of Harris County Public Health. “That’s not the case anymore. It’s now.”

By shutting down events and closing schools, officials aim to “flatten the curve” — to stop too many people from getting sick at the same time and overwhelming the region’s hospitals and medical providers.

Much about the highly contagious new virus remains unknown, and projections of its future behavior vary wildly.

Based on scenarios from the Centers for Disease Control and Prevention, the New York Times estimated that anywhere from 2.4 million to 21 million people in the United States could require hospitalization, “potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds.”

For most people, the virus is expected to be mild. But up to 20 percent of cases — mostly people over 60 or with underlying medical conditions — may require hospitalization.

If everyone gets sick more or less at once, area hospitals almost certainly would not have enough rooms, critical care or ventilators. In Italy, where officials waited to control the outbreak, an extraordinary surge of cases has left the medical system on the verge of collapse.

Based on Harris County estimates, County Judge Lina Hidalgo said recently that if 30 percent of Harris County residents were to become sick at the same time and 20 percent of those people needed hospital care, medical infrastructure would be overloaded.

“We simply do not have enough hospital capacity to assume all of those people,” Hidalgo said. “We can’t afford to have a sudden spike in cases.”

Even the best case — a slowed outbreak that continues for months — is almost certain to pose significant challenges to the area’s hospitals, clinics and doctor’s offices.

[…]

The virus poses particular threats to hospital personnel, who will be working long hours under stressful conditions — and facing coronavirus-related personal problems such as a lack of child care due to school closures. In the worst scenario, seen in China, medical personnel become ill themselves, and their colleagues have to take care of them.

Testifying before Congress earlier this month, Dr. Peter Hotez, a Baylor College of Medicine vaccine researcher and infectious disease specialist, urged that special attention be paid to hospital workers.

“If health care professionals are out of work because they’re sick, or if they’re being taken care of by other health care professionals in ICUs, that’s a disaster,” he said.

And just this weekend, two ER doctors, one in New Jersey and one in Kirkland, Washington, have tested positive for coronavirus. Even with the best preventative measures, this thing is going to spread. All we can do – all that we must do – is take every action we can to try to limit how quickly it spreads. That’s our best hope.

Thus endeth this year’s Rodeo

Surely not a surprise.

Mayor Sylvester Turner announced Wednesday the Houston Livestock Show and Rodeo will close due to concerns about coronavirus after a Montgomery County man with no recent travel history tested positive for COVID-19.

The case is the first example of community spread in the Houston region and was directly responsible for the decision to cancel the Rodeo, Turner and Harris County Judge Lina Hidalgo said at a news conference early Wednesday afternoon. Officials also announced that the man likely attended a barbecue cookoff for the Rodeo late last month, though it was unclear if he had symptoms at the time.

Turner said he will sign an emergency health declaration Wednesday that will remain in place for seven days, at which point City Council will decide whether to extend it. Under the declaration, all events produced or permitted by the city will be canceled through the end of March, Turner said. That includes Sunday’s Tour de Houston fundraising bike ride, which officials will attempt to reschedule, according to the mayor.

Rodeo officials said they were “deeply saddened” but agreed with the city’s move to cancel the livestock show and rodeo.

“As hard as this is to do, it is the right thing to do,” said Joel Crowley, president and chief executive of the Rodeo.

It’s a tough choice to have to make, and there’s a real cost to doing it.

The Houston rodeo generated $227 million in total economic impact last year, directly supporting nearly 3,700 jobs in 2019, according to a study by Economic Analytics Consulting commissioned by the Houston Livestock Show and Rodeo last year. The study measured new spending in the Houston region generated by outside visitors and spending by the Houston Livestock Show and Rodeo Inc.

[…]

The cancellation of CERAWeek, which was expected to bring 5,500 attendees from some 80 countries downtown, cost businesses an estimated $7 million in lost hotel, dining, rental and other direct spending, according to Holly Clapham, chief marketing officer for Houston First Corp., the city’s convention arm.

The rodeo’s cancellation is expected to be more costly for the local economy. It’s known as as the world’s largest entertainment livestock exhibition, and it’s one of Houston’s largest tourist events of the year, lasting for nearly the entire month of March and requiring the efforts of tens of thousands of volunteers.

Last year, the event attracted 273,000 out of town attendees during that time.

Economic projections like this, especially when sourced to the event in question, are unreliable. I don’t think anyone would doubt that the city, and especially the people who work at these events, will suffer for not having them. Still, this was the right thing to do, and will be less costly by any measure than continuing on with business as usual. Let us hope that the need for such drastic action will be short term and not longer. The city of Houston’s press release, which declared a public health emergency along with Harris County, is here. Texas Monthly and the Trib have more.

The state responds to coronavirus

Like it or not, we need to be prepared.

Texas officials are scrambling to remain prepared for a major outbreak of a pneumonia-like disease whose global spread one expert says is now moving into “the next phase.”

From the governor’s office to hospitals to state agencies, Texas officials are intensifying efforts to plan for scenarios that could unfold now that the coronavirus is no longer relatively contained to China and surrounding countries and the number of cases is soaring in countries in Europe and the Middle East.

“I think we need to call an audible,” said Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital. “We need to refresh the algorithms about who’s at risk and when we should suspect someone has the virus. We’re not calling it an epidemic yet, but we should start operating as if it were.”

Hotez said the disease’s spread — the number of cases in Italy and Iran, now about 900, more than doubled in two days, for instance — has made basing screening on the individual’s travel history less relevant. He also noted some recent cases have been characterized by gastrointestinal symptoms rather than respiratory symptoms.

[…]

There are 10 patients with the coronavirus in Texas, including six confirmed by the CDC and four who tested positively in Japan but whose results have not yet been confirmed by the U.S. agency. Of the 10, two came from Wuhan on a State Department-chartered flight and eight came from the Diamond Princess cruise.

There are 15 cases in the U.S. — none in Texas — that weren’t imported.

But CDC officials warned this week that it’s a matter of “when, not if” the virus arrives in the U.S. in larger numbers. The officials said people should start preparing for significant disruptions to daily life.

Noting the alarm that caused in some people who rushed out to buy water or face masks, Dr. Umair Shah, executive director of the Harris County Public Health Authority, said the remarks glossed over the timeline at which the U.S. cases are likely to significantly ramp up. He said that likely won’t be soon.

“The containment strategy in China was effective for giving everyone more time to prepare for the virus,” said Shah, noting the realistic hope was always to delay the virus’ spread, not stop it. “Governments were able to get information out and alert people to be on guard, just as they should be for the everyday flu.”

Three basic things: One, don’t panic. Two, be extra careful about what you read and especially what you share regarding coronavirus. Don’t be one of those idiots who passes along rumors and lies because you couldn’t be bothered to do a little vetting first. And three, practice good hygiene. Cough and sneeze into your elbow, wash your hands frequently, and if you do get sick, stay home. We can all do our part to make a difference.