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And so the re-reopening begins

Are we really ready for this?

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From the “Those who forget the past are condemned to repeat it” department

Who’s ready to re-reopen Texas?

Gov. Greg Abbott signaled he may be preparing to roll back some emergency restrictions put in place this summer at the height of the state’s coronavirus surge.

Responding to concerns from the battered restaurant industry, the governor tweeted Monday night that new infections and hospitalizations from COVID-19 are receding, and added, “I hope to provide updates next week about next steps.”

“Since my last orders in July, COVID numbers have declined—most importantly hospitalizations,” said Abbott, a Republican.

The governor gave no indication about what steps he might take, and a spokesman did not respond to questions. Abbott has previously said he would consider allowing bars to reopen and restaurants to open further if positive trends continue.

Statewide, new daily infections and hospitalizations are declining, though they remain well above where where they were when Abbott began reopening the state in May — hospitalizations are now double, and average new daily infections are four times as high. It’s also unclear whether the rate of people testing positive, a key metric, is anywhere near where public health experts recommend before opening more businesses and allowing children back into schools.

What could possibly go wrong? See here for a statement from Mayor Turner, who unsurprisingly urges caution. You should also read this Politico profile of County Judge Lina Hidalgo, which I will blog about separately, and remember that at every step of the way in this crisis, Lina Hidalgo has been right and Greg Abbott has been wrong.

We’re trending in the right direction, but…

Still a ways to go.

The number of new cases, hospitalizations and deaths from COVID-19 in the Houston area have improved significantly since July, but the pandemic remains a serious threat here.

The Houston region added 1,957 cases on Saturday, according to a Houston Chronicle analysis, bringing the total to 104,650.

Texas as a whole added 4,988 cases and added 138 deaths. The Chronicle has tallied a total of 12,664 virus deaths in the state, though the true figure is likely higher.

The positive test rate fell slightly, from 12.3 percent to 12.2 percent. A troubling sign, however, was a jump in the state’s rolling average of new cases, from 4,997 to 5,369.

Statewide COVID-19 hospitalizations declined for the 11th straight day, to 4,273.

I last posted about this a few days ago, so things aren’t that much different. This story doesn’t have any charts in it, but you can go to Ready Harris and see what they have. (There’s a large blip in the Harris-not-Houston numbers for the past two days, which I’m going to guess is an artifact of test results coming in as a cluster.) As with San Antonio and Dallas and the state as a whole, the numbers are down from the peak but still well above where they were before they began that massive increase in late June. The thing that has made the difference is wearing masks, maintaining social distancing, and avoiding indoor crowds. If we can keep this up, we can get to a point where maybe having kids back in school doesn’t seem like a crazy idea. It’s just that the last time we thought we were making progress, we declared victory and totally let our guard down. Can we please not do that this time? Thanks.

We are finally making progress in getting COVID-19 under control

Good news is always welcome, but be aware of the context.

Houston-area hospitalizations of COVID-19 patients dropped below 900 Sunday, the lowest amount since the summer surge peaked in mid-July.

Some 893 people confirmed or suspected of having COVID-19 were admitted to hospitals in the nine-county area around Houston Sunday, the fifth straight day under 1,000, according to data compiled by the Houston Chronicle. The latest number represents a 67 percent decline since July 14, when hospitalizations hit a high of 2,694.

The last time the number was under 900 was June 15. The number hospitalized then was 820.

COVID-19 related patients in intensive care units also hit a post-surge low Sunday. There were 402 such patients in ICUs Sunday, down from a high of 1,057 July 18. Sunday’s amount was the lowest since June 17, when Houston-area hospitals reported 398 ICU patients.

[…]

The decline in hospitalizations continue a trend of improving COVID-19 numbers in the Houston area. Other key metrics include a TMC COVID-19 positive test rate of 6.7 percent over the past seven days, down from 8.6 percent a week ago and 16.8 percent a month ago; and the 14th straight day in which the rate of the disease’s spread was below 1.0, meaning those infected are passing it on to an average of less than one person each.

That’s all very good, and you should click over to the story to see the embedded charts. I would just note that on the first chart, which shows the daily count of COVID-19 patients in hospitals affiliated with the seven healthcare systems based in the Texas Medical Center, the total daily hospitalizations due to COVID are way down from the peak in July, it’s also more than fifty percent higher than it was in early to mid-June, at the start of the rapid increase in infections. For example, on June 5th the total number of hospitalizations due to COVID-19 (ICU plus general beds) was 537, very close to what it was in mid-April. On August 22, the total number was 908. That is indeed way better than the mid-July peak that topped 2,400, but we still have a way to go and we can’t afford to loosen up just yet.

The story is similar in San Antonio.

The coronavirus positivity rate in Bexar County dipped to 9.9 percent on Monday, a measure that officials consider “very good news” when it comes to efforts to mitigate the impact of the virus.

The positivity rate – the percentage of those tested for the novel coronavirus who test positive – is considered a key indicator of how localities are faring against the coronavirus. Calculated on a weekly basis, it was at 11 percent last week, and Mayor Ron Nirenberg said Monday marked “the first time the positivity rate has been below 10 percent since early June.”

The positivity rate in Bexar County was as high as 25 percent in early July, he said.

With 109 new coronavirus cases reported Monday, the total stands at 45,364 since the pandemic began.

[…]

Local hospitalization rates continue to improve, with 473 people currently being treated at area hospitals, down five from Sunday. Of those, 207 are in intensive care and 139 are on ventilators. However, officials said the hospital system continues to be under high stress.

Four more deaths were reported Monday, raising the overall death toll to 725.

The seven-day moving average (the average number of positives within a 7-day period) in Bexar County increased only slightly to 148 on Monday, but continues to trend in the right direction, officials said.

Again, good news, but again look at the chart. This one shows the seven-day average of new coronavirus cases in Bexar County, which on June 5 was 74 and on August 22 was 137. That’s way down from the peak of 1,600, but still almost double what it once was.

I don’t want to underplay this, these numbers are so much better than they were a month ago, and the trend is clearly going in the right direction. We may get to those April/May/June levels in another week or two at this rate, and that’s excellent. But remember, April is when we were under the strictest shutdown orders, May is when the numbers were at their absolute lowest and also when we started reopening, and June is where it all started to fall apart. We can cautiously start to reopen again once the numbers are back down to these levels, but only if we stay committed to wearing masks and social distancing and avoiding large indoor gatherings. I would like to think that this time we really did learn the lessons we needed to learn to keep this virus at a manageable level, but it would be very easy for us to forget it all again, and repeat this cycle as if we knew nothing. The choice is ours.

Who knows what our positivity rate is?

From the We Still Suck At Data Department:

As schools begin to reopen and Gov. Greg Abbott faces pressure to relax shutdown measures, it is impossible to determine where Texas stands on a COVID-19 metric that has guided the governor’s decisions on when to tighten or loosen restrictions on businesses and public activity.

Over the past week and a half, the state began reporting coronavirus data from a backlog of 500,000 viral tests that officials say accumulated because of coding errors from Quest Diagnostics, Walgreens and CHRISTUS Health — all private entities that process the tests.

The result has been an ongoing miscalculation of the “positivity rate,” the rate at which people test positive for the virus.

Last week, it reached as high as 24.5 percent, and suddenly dipped back down again to about 11 percent this week as more backlogged tests were included in the data. Abbott has said a sustained positivity rate below 10 percent would allow for further reopenings in the state.

The influx of backlogged tests, dating as far back as March, has also exposed a convoluted reporting system that requires state officials to receive lab results, send them back to counties and wait for them to return to the State Department of Health Services before counting them.

The result is a mess of information reported recently to the public in “data dumps” that include test results from months prior, skewing statewide coronavirus statistics and positivity rates.

“The timing of it is horrible because it’s right at the beginning of opening the schools, when you want your data to be as accurate as possible, and it’s not,” said Darrell Hale, a Republican commissioner in Collin County.

The county on Wednesday pasted a disclaimer to its COVID reporting site declaring “no confidence” in the state’s numbers, which Hale said have ballooned in recent days even as lab-confirmed COVID-19 hospitalizations have declined.

[…]

Abbott faulted private labs for the glitches, as well as technological issues in the state’s own reporting system, which did not have the capacity to process more than 48,000 tests per day until Aug. 1. The state did not disclose the issue as it built up throughout July, when as many as 67,000 tests were conducted each day.

It may well be that the private labs can’t keep up with the demand. But:

1. Greg Abbott knew about this problem for at least a few weeks without ever saying anything about it.

2. The positivity rate was and is one of Abbott’s key metrics that were supposed to guide how and when we reopened things. Greg Abbott is currently not allowing local health authorities to make their own decisions about whether it is safe to open schools even though the data that we all need to know what the risks are cannot be trusted.

3. Greg Abbott continues to support and defend the federal government and its completely disastrous response to the pandemic, even though the federal government is the one entity in the country that could have marshaled the responses to meet the demand for testing. Nearly six months into this crisis, the federal government, under Donald Trump, which Greg Abbott supports, has made zero headway on this issue.

So yeah. Our data sucks, we are reaping the consequences of that failure, and the responsibility for it in this state rests with Greg Abbott.

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.

A very early glimmer of some possibly good news

We may be finally bending the curve, thanks to people finally taking seriously the need to wear face masks in public.

Three weeks after Gov. Greg Abbott required Texans to wear masks, epidemiologists and disease modelers say they are cautiously optimistic that the mandate is helping the state turn a corner in its efforts to contain an outbreak that has killed more than 4,500 Texans.

Throughout the summer, Texas’ coronavirus outbreak became grimmer by the day and by almost every metric: case counts, hospitalizations, deaths. But in the past week or so, Abbott and some of the state’s public health officials began to see hope in the daily case counts as they appeared to stabilize.

A growing body of evidence points to widespread mask-wearing as an effective strategy for containing the virus, and one North Texas researcher’s statistical analysis published this week argued that local mask orders in the region reduced viral transmission enough to avoid a lockdown. The governor, who has faced blistering criticism for his handling of the pandemic from members of his own political party, immediately seized upon those findings in defense of his statewide order.

“A community lock down is not needed as long as masks & other distancing strategies are used,” Abbott wrote Monday on Twitter, citing the analysis by Rajesh Nandy, a professor of biostatistics and epidemiology at the University of North Texas Health Science Center.

But public health experts warn that more restrictive lockdowns may still be appropriate in the state’s hardest-hit regions, as the disease continues to infect about 10 times as many people each day compared with two months ago, ravaging some parts of the state more severely than others.

State data now appears to show new daily infections leveling off, albeit at nearly record highs. There were around 9,100 daily new cases of the virus on average over the past week. The state recorded its largest number of daily new cases July 15, at 10,791. On Thursday, that number was 9,507.

“The downside is even though we are approaching another plateau, we are at a much higher level than in May,” Nandy said.

Yes, it would be good news if the case rate stops going up. But it won’t truly be good news until the number of infections starts to go down, and then continues to go down. You know, like it has in New York and Europe and Asia and other places with generally functional governments. It’s when we get the virus down to levels at or below where we were when we first shut down back in March that we can truly contemplate things like safely sending kids back to school and reopening the economy. You’d think this would be something that would be better understood by the elected officials who have been so resistant to taking basic measures to fight COVID-19 – poll data consistently shows that the public understands this, even if they’re not always great about doing it in the absence of leadership – but clearly for some people, these things have to be learned the hard way. And as they are learning this, the hospitals are still at capacity, and could get overwhelmed at any time.

The irony there is that it may take another broad, mostly national shutdown to get to the point we want to get to. That won’t happen under this President, and if it’s still a necessary thing under the next one, then my god have we effed this up beyond all comprehension. In the meantime:

Now Starr County is at a dangerous “tipping point,” reporting an alarming number of new cases each day, data show. Starr County Memorial Hospital — the county’s only hospital — is overflowing with COVID-19 patients.

The county has been forced to form what is being compared to a so-called “death panel.” A county health board – which governs Starr Memorial – is set to authorize critical care guidelines Thursday that will help medical workers determine ways to allocate scarce medical resources on patients with the best chance to survive.

A committee will deem which COVID-19 patients are likely to die and send them home with family, Jose Vasquez, the county health authority, said during a news conference Tuesday.

“The situation is desperate,” Vasquez said. “We cannot continue functioning in the Starr County Memorial Hospital nor in our county in the way that things are going. The numbers are staggering.”

That’s the same Starr County that was once lauded for its low infection rate and ability to keep the virus under control. That was back when local officials had the authority to make and enforce shelter-in-place orders, before Greg Abbott took that authority away. Starr County now plans to issue a new shelter in place order, though of course they won’t be able to enforce it. Greg Abbott could let them enforce it, and he could let other local governments that want to take a step back in an effort to get their numbers down do so, but that’s not something he has any interest in doing. And so here we are.

Here, have a COVID update

Things are going great.

Texas set yet another record for coronavirus deaths Thursday with 154 — the third day in a row above 100.

The previous record was July 8 when 112 deaths were logged, according to a data analysis by Hearst Newspapers that shows the state reported 105 deaths on Wednesday and 104 on Tuesday.

The streak in deaths comes two weeks after Republican Gov. Greg Abbott ordered most of the state’s 30 million residents to wear masks. Despite pressure from local authorities that he give back their ability to mandate stay-at-home orders, Abbott has insisted increased mask-wearing is the key.

Abbott told Houston’s Fox 26 on Thursday that “the last step that would ever be taken is to lock Texans back down” and said other measures would be taken before resorting to that.

“It seems like I get this question a thousand times a day, and there seem to be rumors out there about a looming shutdown,” Abbott said in the interview. “Let me tell you: There is no shutdown coming.”

It will take about three weeks, Abbott said, to see the effects of his mask mandate and his closure of bars in late June. Abbott claimed cases were flattening out in Harris County, though Hearst Newspapers’ analysis shows the county’s rolling average for new cases is more than three times higher than a month ago.

[…]

A new report from Kinsa, a company that uses internet-connected thermometers to predict the spread of diseases, showed that Texas’ rate of illness is spreading faster than those of other states. The company in the past few years has successfully anticipated outbreaks of the flu weeks ahead of the federal government.

The Kinsa data, which tracks whether an uncontrolled outbreak is likely using fever trends and other information, showed that the state is hitting above the threshold for the entirety of the past 30 days.

“This level of sustained, rampant disease transmission suggests that there is likely a lot more illness in the community than what has been reflected in the case numbers to date,” the company said in a press release Thursday. “In other words, there is no relief in store for Texas over the next few weeks, and we fear that the situation there may get much worse in the near-term.”

No, seriously, it’s just terrific.

A coronavirus patient in Anahuac was flown by helicopter to a hospital in El Campo — 120 miles away — because closer facilities could not take him.

Ambulances are waiting up to 10 hours to deliver patients to packed Hidalgo County emergency rooms.

And short-staffed hospitals in Midland and Odessa have had to turn away ailing COVID-19 patients from rural West Texas facilities that can’t offer the care they need.

As the tally of coronavirus infections climbs higher each day, Texas hospitals are taking extraordinary steps to make space for a surge of patients. Some facilities in South Texas say they are dangerously close to filling up, while hospitals elsewhere are taking precautionary measures to keep their numbers manageable.

Doctors warn of shortages of an antiviral drug that shows promise for treating COVID-19 patients. And epidemiologists say the state’s hospitals may be in for a longer, harder ride than places like New York, where hospitals were stretched to capacity in the spring and some parked refrigerated trailers outside to store bodies of people who died from COVID-19.

“It used to [be that] if one hospital got kind of overwhelmed … you would start transferring out ICU patients to other facilities that had ICU beds available,” said Dr. Robert Hancock, president of the Texas College of Emergency Physicians. “And there really is none of that now, because everybody’s in the same boat and they’re struggling to get their own patients admitted.”

You might say we’re red hot.

A document prepared for the White House Coronavirus Task Force but not publicized suggests more than a dozen states should revert to more stringent protective measures, limiting social gatherings to 10 people or fewer, closing bars and gyms and asking residents to wear masks at all times.

The document, dated July 14 and obtained by the Center for Public Integrity, says 18 states are in the “red zone” for COVID-19 cases, meaning they had more than 100 new cases per 100,000 population last week. Eleven states are in the “red zone” for test positivity, meaning more than 10 percent of diagnostic test results came back positive.

It includes county-level data and reflects the insistence of the Trump administration that states and counties should take the lead in responding to the coronavirus. The document has been shared within the federal government but does not appear to be posted publicly.

Dr. Ashish Jha, director of the Harvard Global Health Institute, said he thought the information and recommendations were mostly good.

“The fact that it’s not public makes no sense to me,” Jha said Thursday. “Why are we hiding this information from the American people? This should be published and updated every day.”

[…]

The 18 states that are included in the red zone for cases in the document are: Alabama, Arkansas, Arizona, California, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, North Carolina, Nevada, Oklahoma, South Carolina, Tennessee, Texas and Utah.

The 11 states that are in the red zone for test positivity are Alabama, Arizona, Florida, Georgia, Idaho, Louisiana, Mississippi, Nevada, South Carolina, Texas and Washington.

In May, the World Health Organization recommended that governments make sure test positivity rates were at 5 percent or lower for 14 days before reopening. A COVID-19 tracker from Johns Hopkins University shows that 33 states were above that recommended positivity as of July 16.

“If the test positivity rate is above 10 percent, that means we’re not doing a good job mitigating the outbreak,” said Jessica Malaty Rivera, science communication lead at the COVID Tracking Project, a volunteer organization launched by journalists from The Atlantic. “Ideally we want the test positivity rate to be below 3 percent, because that shows that we’re suppressing COVID-19.”

But don’t worry, Greg Abbott is on it.

As the number of new coronavirus cases in Texas continues to rise and hospitals grow more crowded, Gov. Greg Abbott said Thursday there is no statewide shutdown looming.

Abbott said last week that if the spread of the virus didn’t slow, “the next step would have to be a lockdown.” But in a television interview Thursday, he said that there have been rumors of such a move and stressed that they were not true.

“Let me tell you, there is no shutdown coming,” he told KRIV-TV in Houston.

Abbott pointed to measures he’s taken in recent weeks, including a statewide mask mandate and an order shutting down bars, to slow the spread of the virus. It will take a few weeks to see a reversal in coronavirus case surges, he said.

He has repeatedly stressed this week that, if people wear masks, he’ll be able to avoid shutting down the state. On Wednesday, he told KPRC-TV in Houston that it seems like people ask him about a shutdown “like a thousand times a day.”

“People are panicking, thinking I’m about to shut down Texas again,” he said. “The answer is no. That is not the goal. I’ve been abundantly clear.”

To also be abundantly clear, Abbott is correct that it will take a bit of time for the mask order and other interventions to work, just as there was a lag between the increasing case rate and subsequent increases in hospitalizations and deaths (not that we responded in time for them, but never mind that right now). He is also correct that universal face mask wearing would be a big help, though it may not be enough at this point, and he’s fighting headwinds from Donald Trump and his fellow Republicans on that score. And if we really want to be clear, we need to remember that Abbott mostly speaks in riddles these days, so we turn to an expert in the field for true clarity:

Yes, that’s the kind of straight talk you get from Greg Abbott.

Lawmakers quickly discovered something remarkable. It was possible to stare the man in the eyes, to speak with him for a half-hour or more, and walk away with no better idea of where he stood on important legislative matters. He seemed unwilling to speak forthrightly about nearly anything, drawing a veil around his positions, lest he alienate some key legislator or interest group.

When Abbott did make himself clear, it was to issue marching orders to those who had no reason to follow them, or to punish those who had defied him. “There was no comparison to Perry. [Abbott’s] concept of governing is ordering people around,” Republican state representative Sarah Davis told me in 2018. “He came into the regular session and kind of chided us, and then was absent for the rest of the session.”

And his public statements often contradicted his private ones. Publicly, Abbott endorsed the infamous anti-transgender “bathroom bill” in the 2017 session and pretended to advocate for its passage. But in private he reassured business groups—who worried the state would be boycotted by lucrative conventions and sports tournaments—that the bill would never pass. He was publicly accused of that duplicity by Republican state representative Byron Cook in 2018. The governor’s office has never addressed it.

[…]

Fast forward a few years, through 130,000 American deaths from the coronavirus, at least 3,500 of them from Texas so far, and the onset of the worst economic circumstances since the Great Depression. Now Abbott’s governing style is under strain. Arguably, the root cause of the current crisis is his tendency to talk a lot without saying much and his propensity to take the path of least resistance regardless of the circumstances, especially when confronted by the inchoate demands of the Republican party’s right wing. This modus operandi is on display every time Abbott gets in front of a television camera. But as we see more and more of it, the artifice is becoming more clear. Abbott’s disapproval numbers have been rising just a bit, even as other governors have seen a surge of popularity during the crisis.

Here, we could talk about Abbott’s quadruple-backflip on mask mandates; the time he issued a statewide lockdown disguised under a bureaucratic name while insisting it wasn’t one, before clarifying that it was the next day; the Shelley Luther saga, which saw him ordain that violators of his shutdown order should be punished with fines and jail time only to blame local officials for enforcing it, before retroactively nullifying what he had expressly commanded; or the way he opened the state for business before fixing the problems the lockdown was designed to address.

But instead, let’s consider a small but important test Abbott recently faced, one that seems instructive. Abbott’s party had long been planning to hold its state convention in Houston, one of the nation’s biggest coronavirus hot spots, which would have brought some six thousand attendees, many of them older and especially vulnerable to the virus, from all around the state for a crowded three-day fete. An in-person convention was a virtual guarantee that some delegates and service workers would get infected and possibly die, and that Houston’s seemingly potent strain of the virus would be spread around the state.

It was an incredibly bad idea that Abbott’s party nonetheless seemed hell-bent on pursuing. What did the governor have to say about it? Would he speak up, in an attempt to save the lives of his own party’s activists? “You’re the top Republican in the state, governor,” said an anchor for KDFW in Dallas on July 6, after Houston mayor Sylvester Turner begged the party to call off the gathering, then canceled it two days later. “What do you think should happen?”

The governor’s answer: “I know that the executive committee for the Republican Party of Texas have been talking about this. I think they continue to talk about it, and they weigh all of the consequences and the public health and measures … They’ll make a decision.”

The anchor persisted: “You don’t want to weigh in on what you think should happen?”

The governor paused and then gave his answer: “Obviously I think whatever happens—whether it be, listen, this convention or any action that anybody takes—we’re at a time with the outbreak of the coronavirus where public safety needs to be a paramount concern, and make sure that whoever does anything and whatever they do, they need to do to reduce the spread of the coronavirus.”

Huh?

A day later, an anchor for KENS in San Antonio tried a different tack: “Will you be attending in person?” Abbott dissembled, so the anchor tried again. “Yeah, listen, as for myself, as well as for everybody else,” Abbott said, “we will continue to see what the standards are that will be issued by the State Republican Executive Committee, by the state Republican Party to determine what the possibility will be for being able to attend.” To determine what the possibility will be for being able to attend.

Not only could Abbott not say whether he thought the convention was a good idea, he couldn’t even say whether he would be there. The interview went out during the KENS five o’clock broadcast. Not half an hour later, during a meeting of the SREC, the party’s executive director announced that elected officials would be pre-recording messages instead of giving in-person speeches. Abbott surely knew this important fact when he was on the air.

I hope this clears everything up.

The hidden toll

Another reason why the reported death count from COVID-19 is too low: People who didn’t know they were infected and die at home may never be tested or counted.

As coronavirus cases surge, inundating hospitals and leading to testing shortages, a rapidly growing number of Houston area residents are dying at home, according to an NBC News and ProPublica review of Houston Fire Department data. An increasing number of these at-home deaths have been confirmed to be the result of COVID-19, Harris County medical examiner data shows.

The previously unreported jump in people dying at home is the latest indicator of a mounting crisis in a region beset by one of the nation’s worst and fastest-growing coronavirus outbreaks. On Tuesday, a record 3,851 people were hospitalized for the coronavirus in the Houston region, exceeding normal intensive care capacity and sending some hospitals scrambling to find additional staff and space.

The uptick in the number of people dying before they can even reach a hospital in Houston draws parallels to what happened in New York City in March and April, when there was a spike in the number of times firefighters responded to medical calls, only to discover that the person in need of help had already died. These increases also echo those reported during outbreaks in Detroit and Boston, when the number of people dying at home jumped as coronavirus cases surged.

While far more people died of COVID-19 in those cities than have died so far in Houston, researchers and paramedics say that the trend of sudden at-home deaths in Texas’ largest city is concerning because it shows that the virus’s toll may be deeper than what appears in official death tallies and daily hospitalization reports.

Many people who die at home are not tested for COVID-19, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. In New York City, for example, only 16 percent of the 11,475 at-home deaths between February and June have been attributed to COVID-19, according to data from the U.S. Centers for Disease Control and Prevention.

“There’s no reflexive testing,” Faust said, noting that medical examiners are selective about the cases they take. “There’s no pressure to call it a COVID death.”

The rise in at-home deaths may also reflect people who are afraid to go to the hospital because of COVID-19, and who die of heart attacks, strokes, diabetes and other conditions not tied to the coronavirus, Faust said.

Ultimately, Faust said, public health experts trying to assess the toll from COVID will need to study how many excess deaths there are in a particular region and whether the demographics of those who died are different from what one might expect. “If there’s a huge spike in at-home deaths but no real spike in overall deaths, it’s just sort of rearranging deck chairs.”

There’s more, so go read the rest. I don’t have anything to add other than the usual disclaimer that none of this had to happen. We could have had a federal government that actually prepared for COVID-19. We could have had a state government that cared about reopening in a safe and scientifically-driven manner. We have neither of those things – yet – and so here we are. Keep that in mind, today and every day, not just through this November, but through November of 2022.

Who wants to enforce Greg Abbott’s mask order?

Anyone? Anyone? Bueller?

Gov. Greg Abbott called on police across Texas to step up enforcement of his mask order amid the mounting pandemic, explaining Thursday that they can either “be part of the problem or part of the solution.”

Facing a revolt over the mandate within his conservative base, the governor acknowledged in a new round of interviews that masking is inconvenient, but said the alternative of locking the state down again is far worse.

“We have a short period of time in the next couple of weeks to bend the curve of this explosion in cases and hospitalizations,” he said in an interview on KSAT in San Antonio. “If we can enforce this, we will be able to keep the state open and reduce hospitalizations.”

Some local law enforcement officials, including the sheriffs in Montgomery and Gillespie counties, have refused to enforce the new order, citing personal liberties or enforcement logistics. On Wednesday, the Montgomery County Republican Executive Committee voted 40-0 to censure Abbott, joining at least three other county executive committees that have taken similar steps.

It’s more than just a few.

When Gov. Greg Abbott issued a statewide executive order requiring Texans to wear masks in public, he gave counties the opportunity to opt out if they have a low number of active coronavirus cases.

A week later, 78 counties have taken him up on that offer. And a handful of other local governments have insisted that they won’t enforce the order even though they don’t qualify for the opt-out provision. Officials cited a desire to preserve personal freedoms or concerns about enforcement.

“I think it’s an insult to Texans to be required to do something they should have discretion for,” said Hugh Reed, the top administrator for rural Armstrong County, near Amarillo, which opted out.

In a press release announcing the order, Abbott said that “wearing a face covering in public is proven to be one of the most effective ways we have to slow the spread of COVID-19.” Public health experts broadly agree that masks slow the spread of the virus, and the Centers for Disease Control and Prevention recommend face coverings for anyone 2 or older in public settings.

The order came as coronavirus cases have grown quickly in the state. As of Thursday, more than 9,600 people were hospitalized with the virus.

In order to opt out of the requirement, the counties need to have 20 or fewer active COVID-19 cases. Given the spread of the virus in recent weeks, only counties that are sparsely populated and rural tend to qualify. Most are in conservative areas of the state.

Rex Fields, the top elected official in Eastland County, said Abbott’s option for counties with low coronavirus case counts “gives people some personal freedom.”

But a few local officials without that freedom are also choosing not to enforce the order. In Montgomery County, which has a population of over 600,000 and has reported more than 2,700 coronavirus cases so far, the sheriff’s office said July 3 that it would not take action on the mask rule.

“This order includes specific language prohibiting law enforcement from detaining, arresting, or confining to jail as a means to enforce the order,” the agency wrote in a press release. “This language strips law enforcement of the necessary tools to enforce compliance with the law.”

Yeah, so maybe undermining the rule of law was not a great idea. Greg Abbott could be in a position to insist that his order be enforced, if only Greg Abbott hadn’t so clearly demonstrated that Greg Abbott’s executive orders regarding COVID-19 are just suggestions.

That said, some places are more serious about trying to stop the spread of COVID-19.

Gov. Greg Abbott signaled his encouragement Wednesday to Austin city leaders to move forward on “additional enforcement mechanisms” related to a recent order Abbott issued requiring Texans to wear masks in most public spaces.

In a letter to Austin Mayor Steve Adler, Abbott said the city’s consideration of new enforcement measures “to ensure compliance with my Executive Orders is an important step toward reducing the spread of the novel coronavirus (COVID-19).”

“As you know, these Orders were created and adopted based on advise from medical experts, and if these Orders are followed, we will be able to protect both public health and the livelihoods of our citizens,” he added.

The Austin-American Statesman reported Wednesday that the City Council will meet Thursday “to vote on a resolution that would allow for a fine of up to $2,000 for anyone violating a ‘health authority rule’ like not wearing a mask” and to take “civil action against any person who maintains a business or site that does not comply with minimum health standards.”

Another riddle solved, apparently. That resolution passed unanimously on Thursday. I’m sure it’s just a matter of time before the Hotze contingent files a lawsuit against this, but in the meantime it’s something. (Hey, Greg! Now do letting counties issue stay-at-home orders.)

Now to be fair, if I’m going to advocate for letting local authorities have some of their authority to make local decisions back, I’m going to be circumspect about criticizing a small rural county with a still-low infection rate for not wanting to enforce a mask order. But let’s be clear that all parts of the state are vulnerable, and those lightly populated places also tend to be many miles away from hospitals, so their residents are in greater jeopardy should they get sick. The approach I’m looking for here is one that says “this is the minimum that counties must do – they can go above and beyond it within reason, but they have to do at least this much”. That philosophy has been distinctly lacking in recent years in this state.

But here we are, and here we once again face the worst case scenario, at least as far as Greg Abbott is concerned.

With Texas continuing to break records for new coronavirus deaths and hospitalizations this week, Gov. Greg Abbott reiterated Friday afternoon that things will continue to get worse. And if people keep flouting his new statewide mask mandate, he said, the next step could be another economic lockdown.

“Things will get worse, and let me explain why,” he told KLBK TV in Lubbock. “The deaths that we’re seeing announced today and yesterday — which are now over 100 — those are people who likely contracted COVID-19 in late May.

“The worst is yet to come as we work our way through that massive increase in people testing positive.”

Texans will also likely see an increase in cases next week, Abbott said, and people abiding by his face mask requirement might be the only thing standing between businesses remaining open and another shutdown.

“The public needs to understand this was a very tough decision for me to make,” Abbott told KLBK of his face mask mandate. “I made clear that I made this tough decision for one reason: It was our last best effort to slow the spread of COVID-19. If we do not slow the spread of COVID-19 … the next step would have to be a lockdown.”

And then when sheriffs in heavily Republican counties refuse to enforce that, then what? Say it with me now: None of this had to happen. But it did, and it’s Greg Abbott’s fault.

How Texas screwed it all up

That’s a more succinct headline for this story about how Texas went from having a low COVID-19 infection rate to one of the worst in the country. And the vast majority of the responsibility for this is on Greg Abbott.

In Houston, the largest medical campus in the world has exceeded its base intensive care capacity. In the Rio Grande Valley, elected officials pleaded this week for military intervention to avoid a “humanitarian crisis.” And in several major cities, testing sites are overrun, with appointments disappearing in minutes and hundreds waiting in line for hours.

Eight weeks ago, the White House lauded Texas as a model for containing the COVID-19 pandemic.

Now, Gov. Greg Abbott’s plan to reopen the economy has unraveled as the state struggles to contain one of the worst outbreaks in the country.

“We’re on the verge of a nightmarish catastrophe,” said Vivian Ho, a health economist at Rice University and the Baylor College of Medicine. “On May 1, I thought we actually had a chance to get this virus under control and get the economy opened up safely. I’m not sure we can get it under control anymore.”

Public health experts say the worst of the crisis was avoidable in Texas, where Abbott stripped local officials of the ability to manage their own outbreaks and until Thursday refused to mandate masks and other basic mitigation practices. The governor reopened before the state could adequately monitor the virus, health experts said, then ignored signs in late May that infections were beginning to run rampant.

“That is the point at which you say hang on a sec, we’re staying where we are, and are probably taking a step back to understand the scale of the problem here,” said Bill Hanage, an associate professor of epidemiology at Harvard’s T.H. Chan School of Public Health.

Without the tools in place to test quickly for infections and track those exposed, authorities believe the state was left blinded as the virus spread among younger Texans, who are less likely to develop symptoms.

Spokesmen for Abbott and state Health Commissioner Dr. John Hellerstadt did not respond to requests for comment. Asked at a televised town hall Thursday why he had not mandated masks sooner, the governor said the “data was only recently bad.”

“It was only in the past couple of weeks that we saw this spike in people testing positive,” Abbott said.

[…]

On April 27, Abbott said he would reopen the state in phases based on data and guidance from medical professionals, pledging not to simply “open up and hope for the best.”

His advisers laid out four criteria to guide the reopening: a two-week reduction in cases, hospital capacity for all patients, the ability to to conduct 30,000 daily viral tests and hire 4,000 contact tracers.

Abbott, however, did not commit to following them. Only in mid-June would the state begin meeting its testing goal. It has yet to hire enough contact tracers or see a sustained drop in infections.

He said the plan was designed to be applied regionally, with lighter restrictions imposed in areas with few cases, then overruled officials from large counties who tried to enact more restrictive edicts.

Abbott punctuated that point by effectively gutting Harris County Judge Lina Hidalgo’s April 22 mask order when he stripped the ability of local governments to punish residents who violated such mandates.

Several prominent Republicans, including Lt. Gov. Dan Patrick and U.S. Rep. Dan Crenshaw, had condemned Hidalgo’s order and its potential $1,000 fine as an abuse of power. They have continued to argue that the severity of the virus is being embellished, and some have even questioned whether masks are effective at stopping it from spreading.

The mask debate — which took another turn Thursday when Abbott issued his own statewide mandate — has sent mixed messages that may have left residents with the impression that face coverings are unimportant, said Dr. Gregory Tasian, an associate professor at the University of Pennsylvania Perelman School of Medicine.

“Without a clear direction from the state level, some of those masking policies become much less effective,” Tasian said.

There’s more, but you get the idea. I’ve said this before and I’ll say it again, Abbott never made any effort to meet those four metrics that he himself and his vaunted “Strike Force” laid out. (By the way, when was the last time you saw a news story about COVID-19 in Texas refer to the “Strike Force”?) Each time he relaxed another part of the previous restrictions in order to push reopening further, I pointed out that we had no plan and no reason to proceed as if everything was going to plan. All we had was hope and distraction, and look where that has gotten us. The extremely “mixed messages” (to put it lightly) about masking and social distancing was another huge problem, one that also didn’t have to happen. I get that Abbott felt pressure from Donald Trump and from the screaming howler monkeys of our state like Dan Patrick, but for Christ’s sake he’s the Governor, he’s got a gazillion dollars in his campaign treasury and by far the highest approval ratings of anyone in the state, and it’s his fucking job to be a leader. He failed at that at every step of the way.

What’s even more appalling is that he already had a model that was working for him, and that was to get out of the way of the local leaders, who were uniformly ahead of him on all the mitigation steps we first took back in March. It would have been perfectly consistent with his stated belief that some parts of the state needed more restrictions than others to let Lina Hidalgo and the other county judges impose face mask orders and keep a tighter rein on businesses as they saw fit. I believe it would have been politically expedient for him as well, since the raging assholes would have aimed all their fury and lawsuits at them instead of at him. It was when he caved in the most cowardly way possible to Shelley Luther, who was being held accountable to HIS OWN EXECUTIVE ORDER by a Dallas County judge that we all should have known what was coming next. Sure is funny how the cries for “law and order” get silenced when it’s a white suburbanite being taken to court.

I also want to note the bit in this story about nobody on Team Abbott responding to requests for comment. Another hallmark of this crisis, which has been a recurring theme of the Abbott reign in general, has been the way he operates in a closed and non-transparent fashion. He does the things he does, on his own and in consultation with no one outside his bubble, with no mechanism for feedback or consideration of other perspectives. I can’t help but think that this style has not done him any favors lately, and I expect it will result in a Legislature that doesn’t feel much need to defer to him or his priorities in 2021, and that’s even if the Republicans manage to hang onto the House. And, as some people have speculated, he could be headed for a challenge from the right in the 2022 primary. I doubt that my own preferences here would do anything to dissuade such a challenger. But a better outcome from the pandemic might go a long way towards shoring up his political position.

So here we are, and as bad as things are right now, they are certain to get worse in the short term, because that’s the way this virus operates. If we’re very lucky, the mask order and mild dialing back of reopening might make things be less bad. But it’s going to be bad. And it didn’t have to be. It’s Greg Abbott’s fault that it is.

Abbott finally issues a mask order

Better late than never, but it’s pretty damn late.

Gov. Greg Abbott issued a nearly statewide mask mandate Thursday as Texas scrambles to get its coronavirus surge under control.

The order requires Texans living in counties with 20 or more positive COVID-19 cases to wear a face covering over the nose and mouth while inside a business or other building open to the public, as well as outdoor public spaces, whenever social distancing is not possible. But it provides several exceptions, including children who are younger than 10 years old, people who have a medical condition that prevents them from wearing a mask, people who are eating or drinking and people who are exercising outdoors.

The mask order goes into effect at 12:01 p.m. Friday.

The order represents a remarkable turnaround for Abbott, who has long resisted such a statewide mask requirement, even as the coronavirus situation has gotten worse than ever over the past couple weeks in Texas. When he began allowing Texas businesses to reopen this spring, Abbott prohibited local governments from punishing people who do not wear masks. As cases began to rise earlier this month, he clarified that cities and counties could order businesses to mandate customers wear masks.

In recent days, though, Abbott had held firm against going further than that, saying he did not want to impose a statewide requirement that may burden parts of the state that are not as badly affected by the outbreak.

Abbott on Thursday also banned certain outdoor gatherings of over 10 people unless local officials approve. He had previously set the threshold at over 100 people. The new prohibition also goes into effect Friday afternoon.

[…]

Abbott’s announcement came a day after the number of new daily cases in Texas, as well as hospitalizations, reached new highs again. There were 8,076 new cases Wednesday, over 1,000 cases more than the record that was set the prior day.

Hospitalizations hit 6,904, the third straight day setting a new record. The state says 12,894 beds are still available, as well as 1,322 ICU beds.

Abbott has been particularly worried about the positivity rate, or the share of tests that come back positive. That rate, presented by the state as a seven-day average, has jumped above its previous high of about 14% in recent days, ticking down to 13.58% on Tuesday. That is still above the 10% threshold that Abbott has long said would be cause for alarm amid the reopening process.

First-time offenders of Abbott’s order will receive a written or verbal warning. Those who violate the order a second time will receive a fine of up to $250. Every subsequent violation is punishable also by a fine of up to $250. The order specifies that no one can get jail time for a violation.

Remember that PolicyLab projection from May that said Harris County would go from 200 cases a day to over 2,000 by now? Thankfully, we’re still not close to that – the ReadyHarris dashboard has mostly shown us in the 600 to 800 cases per day range recently, though I suspect there’s some lag in the data because there’s no reason why this week would be lower than the two previous weeks. Point being, we most certainly could have seen this coming, and we could have done a lot to protect ourselves before this happened. You know, like having mask orders in place all along, and letting local governments have more leeway to control crowd sizes. Note here that Abbott’s order targets outdoor gatherings, but not indoor gatherings. You know, like this one. I don’t understand the logic here, but whatever.

The real question is after all this time and all that bullshit from Republicans like Dan Patrick, how much resistance do you think there will be to this new order? Like, remember when Dan Patrick called Judge Hidalgo’s mask order “the ultimate government overreach”? Also, too, Jared Woodfill and Steven Hotze are suing to basically stop emergency orders, and had previously sued to stop Judge Hidalgo’s mask order, before Abbott overruled it himself. Our state has plenty of people who will perform their rage over being asked to take the health and well-being of their neighbors into consideration. I’m curious, and more than a little afraid, to see how that segment of our population reacts to this. The Current, the Press, and the Dallas Observer have more.

UPDATE: My God, but Dan Crenshaw is a hack.

How it’s going at the hospitals

In a word, it’s bad.

At Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.

A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.

And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.

These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care.

“To tell you the truth, what worries me is not this week, where we’re still kind of handling it,” said Roberta Schwartz, Houston Methodist’s chief innovation officer, who’s been helping lead the system’s efforts to expand beds for COVID-19 patents. “I’m really worried about next week.”

What’s happening in Houston draws eerie parallels to New York City in late March, when every day brought steep increases in the number of patients seeking care at overburdened hospitals — though, so far, with far fewer deaths. But as coronavirus cases surge in Texas, state officials here have not reimplemented the same lockdown measures that experts say helped bring New York’s outbreak under control, raising concern among public health officials that Houston won’t be able to flatten the curve.

“The time to act and time to be alarmed is not when you’ve hit capacity, but it’s much earlier when you start to see hospitalizations increase at a very fast rate,” said Lauren Ancel Meyers, a professor of integrative biology who leads the University of Texas at Austin COVID-19 Modeling Consortium. “It is definitely time to take some kind of action. It is time to be alarmed.”

[…]

Although hospital executives in Houston stress that they have the ability to add additional intensive care beds in the region to meet the growing demand — for a few more weeks, at least — the strain on hospitals is already being felt in other ways.

Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.

Part of the problem, Peña said, is that when his crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”

“If they don’t have the nursing staff, then you can’t place the patient,” Peña said. “Then our crews have to sit with the patient in the ER until something comes open. It has a huge domino effect.”

There’s more, so read the rest. If you’re thinking that the death rate is low and that that’s a small blessing, that is true, but it’s also a bit illusory. For one thing, the sheer number of deaths will increase as the infection rate rises, not all deaths for which COVID-19 is a factor are recorded as COVID-19 deaths, and it is already the case that people are avoiding going to the hospital now for other reasons because of COVID-19, and that some of them will also die as a result. The official death count numbers have always been underestimated, and there’s no good way to spin it. Even if we were to go into total lockdown right now, we won’t begin to see the positive effects of that for another two weeks. We really need masking and better social distancing to have an effect or it’s going to get much worse. Oh, and the Texas Medical Center is above 100% ICU capacity. So we’ve got that going for us.

And as you ponder all that, ponder also this.

Despite Texas’ surge of new COVID-19 cases and hospitalizations, Lt. Gov. Dan Patrick said Tuesday evening that he doesn’t need the advice of the nation’s top infectious disease doctor, Anthony Fauci.

“Fauci said today he’s concerned about states like Texas that ‘skipped over’ certain things. He doesn’t know what he’s talking about,” Patrick told Fox News host Laura Ingraham in an interview. “We haven’t skipped over anything. The only thing I’m skipping over is listening to him.”

Patrick also said Fauci has “been wrong every time on every issue,” but did not elaborate on specifics.

Dan Patrick does not care if you live or die. You and everyone you know mean nothing to him.

Put a pause on that reopening

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.

Who needs testing?

Not a great idea.

The Trump administration is planning to end federal support for some coronavirus testing sites across the nation at the end of the month — including seven in Texas, where confirmed cases of COVID are spiking.

An array of Texas officials from the city to the state House and Congress are urging the White House to rethink the move, warning of “catastrophic cascading consequences” of pulling federal support for testing sites, four of which are in Houston and Harris County and administer thousands of tests per day. City officials say the sites won’t close, but keeping them open without federal help will drain much-needed resources as the city works to expand testing and build a contact tracing network.

A Trump administration official said the sites are part of a “now antiquated program” the federal government is moving away from as it works to expand testing options. But Houston officials consider two of those sites — the largest in the city, administering up to 500 tests each per day — the backbone of its testing efforts.

Texas has seen a 146-percent increase in lab-confirmed COVID-19 hospitalizations since Memorial Day and Houston could soon be the country’s worst-hit city, health officials have warned.

“Now is the time to be ramping up our testing capabilities, not slowing it down,” said U.S. Rep. Sylvia Garcia, a Houston Democrat who led a letter to the heads of FEMA and Health and Human Services on Tuesday. Houston Democratic U.S. Reps. Sheila Jackson Lee, Al Green and Lizzie Fletcher also signed the letter.

Also pushing back on the plan is a group of 20 members of the Texas House and Senate representing Harris County and U.S. Sen. Ted Cruz, a Republican.

[…]

The Trump administration has long planned to end federal support for the sites and transition them to state and local control. It has pushed back the plan at least once, in April, when it extended support for the sites until the end of June at the urging of local lawmakers including Houston Democrats and the state’s Republican U.S. Sens. John Cornyn and Cruz.

Officials are asking the administration to to push the deadline back to the end of August, saying ending federal support for the sites now could hinder attempts local attempts to build up contact tracing networks and other efforts to control the outbreak.

Houston Mayor Sylvester Turner said on Wednesday that the city will keep the testing sites open, but it will strain the city’s resources to do so. The city’s health department is working on a transition plan as officials push for the federal government to reconsider.

The federal government should be paying for this. It’s not even a question. This is not something that should be competing for city financial resources. Turn on the federal spigot, and keep it on until we don’t need testing at scale anymore. I can’t believe we are having this discussion.

Credit to Talking Points Memo for breaking the original story, which has been picked up by national media, and which apparently led to an epic meltdown by the spokesperson for HHS on a conference call with reporters. The Trib has more.

Have we gone from “concerned” to “alarmed” yet?

We’re getting there.

With cases of the coronavirus surging to record levels in Texas, Gov. Greg Abbott recommended Tuesday that Texans stay home as much as possible and for the first time moved to allow the tightening of two kinds of restrictions that had been eased under his reopening plan.

“We want to make sure that everyone reinforces the best safe practices of wearing a mask, hand sanitization, maintaining safe distance, but importantly, because the spread is so rampant right now, there’s never a reason for you to have to leave your home,” Abbott said during an early-afternoon interview with KBTX-TV in Bryan. “Unless you do need to go out, the safest place for you is at your home.”

Within hours, Abbott made two announcements to alter the reopening process. He scaled back a previous statewide order and gave local officials the ability to place restrictions on outdoor gatherings of over 100 people, a threshold he originally set at 500 people. And Abbott said the state would enact mandatory health standards for child care centers after prior rules became voluntary earlier this month.

The moves came a day after Abbott said at a news conference that the coronavirus was spreading at an “unacceptable rate” but did not offer any new policies to stem the virus’ spread. Instead, he reiterated long-established guidelines such as social distancing and pointed out that the state was increasingly cracking down on businesses that allow large crowds. At the news conference, Abbott also encouraged Texans to stay home, albeit in less explicit terms than he did in the KBTX interview.

The Monday news conference marked a newly urgent tone by Abbott, which he continued into Tuesday. During TV interviews in the noon hour, he made the somewhat unusual move of getting ahead of the state’s daily announcement of new coronavirus cases, bracing audiences for a new record high exceeding 5,000 — a big increase over the last peak of 4,430 on Saturday.

Before sharing the new record figure with KBTX, Abbott said he was trying to “make sure people around the state really comprehend the magnitude of the challenge we’re dealing with.”

By the end of the afternoon, the state Department of State Health Services had reported the precise number: 5,489 new cases.

At the same time, two metrics that Abbott has prioritized — hospitalization levels and positivity rate — continued to trend in the wrong direction. Hospitalizations reached 4,092, marking the 12th straight day of a new peak. The positivity rate — or the ratio of cases to tests, presented by the state as a seven-day average — reached 9.76%, back to the level it was at in mid-April.

It’s bad, y’all.

The Texas Medical Center’s intensive care capacity could be exceeded as soon as Thursday because of the surge in COVID-19 patients, the hospital system projects.

A TMC model also predicts ICU surge capacity — extra, temporary beds and equipment used in emergencies — could be exceeded as soon as July 6 if the steep rate of new COVID hospitalizations continues, the most aggressive modeling to date.

Eleven leaders of the system’s member hospitals and medical schools said in a joint statement that COVID-related admissions were increasing at an “alarming rate,” stretching the capacity of ICU units. Texas Children’s Hospital this week began admitting adult patients to handle the surge.

“If this trend continues, our hospital system capacity will become overwhelmed, leading us to make difficult choices of delaying much-needed non-COVID care to accommodate a greater number of COVID patients,” the group wrote.

The leaders urged residents to stay home when possible, practice social distancing and wear masks.

Stay home.

Houston employers ought to send workers back home from the office if possible due to spiking coronavirus cases in the region, the region’s leading business group said Wednesday.

Bob Harvey, the president and CEO of the Greater Houston Partnership, said in a statement that Houston COVID-19 cases are reaching a “critical point” and that employers need to do their part in helping to curb what he called an “alarming trajectory.”

“We encourage employers to strongly consider returning to a work-from-home model,” Harvey said. “To keep our Houston economy moving forward, we must all do our part.”

On Tuesday, Gov. Greg Abbott asked Texans to voluntarily stay home if possible.

We’re basically back where we were in March and April, with county governments still trying to figure out what to do without clear direction from the state and a complete abdication of responsibility from the White House. The Texas Restaurant Association is calling for a statewide face mask mandate, a thing that is very much necessary now but could have done so much more good a month ago when we were in this mad stupid rush to reopen everything. Imagine if we could have been able to reopen without thousands of people getting sick every day? Too bad, that’s not how it went. What we’re doing now – and what we’re still not doing because Greg Abbott still isn’t doing it – is definitely too late. If we’re very lucky, maybe it won’t be too little. The Chron has more.

UPDATE: Oh, the irony.

Visitors from Texas will soon have to quarantine for 14 days if they travel to New York, New Jersey, or Connecticut, according to the three states’ governors, who also took aim at Texas’ handling of the coronavirus outbreak on Wednesday.

The move comes as coronavirus cases and hospitalizations hit record highs in Texas, surpassing 5,000 new cases in a single day on Tuesday and making the state one of the country’s coronavirus hotspots.

Gov. Andrew Cuomo of New York, Gov. Phil Murphy of New Jersey, and Gov. Ned Lamont of Connecticut, all Democrats, held a joint press conference Wednesday to announce the policy, which will affect nine states whose infection rates have met thresholds indicating “significant community spread,” including Texas, Arizona, and Florida, according to reports.

“We need to do things right inside the four walls in our respective states,” Murphy told reporters.

The restriction on Texas travelers marks a notable shift in which states are being flagged nationwide for the most alarming increases of coronavirus cases. Earlier in the pandemic, Texas touted comparatively low hospitalization rates and was pointing the finger at other states where the virus was raging.

In late March, Texas imposed a 14-day quarantine on travelers from New York, New Jersey, Connecticut, Washington, and California – some of the early coronavirus hotspots. The state also mandated quarantines for those driving or flying to Texas from neighboring Louisiana as well as flying from Miami, Atlanta, Detroit, and Chicago. Those orders have since been lifted.

Abbott did not respond to a request for a comment for this story, but that’s all right. We know what he’d have said: He’s “concerned, but not alarmed”. You’re welcome.

Whistling past the ICU

Clap louder!

Gov. Greg Abbott and top Texas health officials on Tuesday responded to growing alarm over hospitals now swelling with coronavirus patients, assuring there is still plenty of space available even as some facilities have neared or surpassed capacity.

Speaking on yet another day of record high hospitalizations from the pandemic, Abbott said he is confident the state can continue reopening while controlling the spread of new infections.

“As we begin to open up Texas and Texans return to their jobs, we remain laser-focused on maintaining abundant hospital capacity,” said Abbott, a Republican. “The best way to contain the spread of this virus is by all Texans working together and following simple safety precautions.”

On Tuesday, the Department of State Health Services reported just over 2,500 COVID-19 patients in Texas hospitals, the highest single-day total since the pandemic began and nearly 67 percent more than on Memorial Day in late May. State and local leaders have pointed to the holiday weekend as one likely cause for the increase.

Statewide, there are still thousands of hospital beds and ventilators available. But in some of the largest cities, including San Antonio and Houston, the surge is pushing new limits. In Harris County, some hospitals said late last week that their intensive care units were near or above capacity.

Bill McKeon, CEO of the Texas Medical Center, said their number of COVID-19 patients has nearly doubled from its previous peak in late April. Many of the patients admitted now are younger and generally healthier, but are still susceptible to serious illness or death from the disease.

“If it continues to grow at this rate, we’re going to be in real trouble,” McKeon said of the admissions. He added that while it may not be feasible to reimpose lockdowns or other restrictions, state leaders should consider slowing the reopening if the uptick continues.

The official death count is past 2,000 now, though everyone knows that’s an undercount. On a per capita basis that’s still pretty low, but we’re doing our best to catch up. The idea that we’re “controlling the spread” in any fashion is laughable, except there’s nothing funny about what’s happening. And then we get this:

Abbott remained unwilling Tuesday to allow local officials to enforce their own mask ordinances, even as he acknowledged that many Texans are not wearing them. He instead accused Democratic county judges of not having done enough to punish businesses that fail to comply with other protocols, such as limits on public gatherings.

While they have the authority, Abbott said, many “haven’t lifted a finger.”

Hey, remember when Greg Abbott cravenly flip-flopped on consequences for not following his own executive orders? Good times, good times. What would you like the county judges to use, harsh language? Let’s not forget who’s in charge here.

But local officials are still trying, at least:

The mayors of nine of Texas’ biggest cities urged Gov. Greg Abbott in a letter Tuesday to grant them the “authority to set rules and regulations” mandating face masks during the coronavirus pandemic.

As COVID-19 cases and hospitalizations continue to climb in Texas, an executive order from Abbott bans local governments from imposing fines or criminal penalties on people who don’t wear masks in public. The mayors wrote that many people in their cities continue to refuse to wear face masks and that “a one-size-fits-all approach is not the best option” when it comes to regulating the issue.

The letter is signed by Houston Mayor Sylvester Turner, San Antonio Mayor Ron Nirenberg, Austin Mayor Steve Adler, Dallas Mayor Eric Johnson, Fort Worth Mayor Betsy Price, El Paso Mayor Dee Margo, Arlington Mayor Jeff Williams, Plano Mayor Harry LaRosiliere and Grand Prairie Mayor Ron Jensen.

The letter asks Abbott to consider allowing each city’s local officials to decide whether to require the use of a face covering in order to prevent the spread of the virus.

Mayor Turner’s press release is here, and a copy of the letter sent to Abbott is here. There was no response as of Tuesday afternoon.

Finally, let’s not forget that even as businesses may want to reopen, coronavirus may not let them. It’s almost as if an unchecked pandemic is a hindrance to having your economy run at full capacity. But don’t worry, Greg Abbott has everything under control. Now keep clapping!

Threat level orange

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.

We keep hitting the wrong marks

Up, up, and up.

For the second day in a row, Texas has reported a record number of patients hospitalized with the new coronavirus, a metric Gov. Greg Abbott has said he’s watching as businesses continue reopening and limits on their operations are loosened.

Data released Tuesday by the Texas Department of State Health Services shows 2,056 people were hospitalized with COVID-19, up from 1,935 the day before. The previous high was May 5, when 1,888 people were hospitalized.

The figures come a little more than a month since Abbott’s statewide stay-at-home order ended and he began a phased reopening of businesses. It also comes about two weeks after Memorial Day.

[…]

“I’m concerned but not yet alarmed,” Abbott told a North Texas television station. “I look at Amarillo that was a hot spot zone a couple of weeks ago, where they had a lot of concerns. We had surge response teams that addressed it, and now their hospitalizations are going down.”

Texas has 15,400 available hospital beds and 1,700 available ICU beds, the data shows. There are 5,900 ventilators available. The number of available beds is seen as a key gauge for the state’s ability to handle a potential surge in coronavirus cases, and Abbott has said the hospitalization rate — the proportion of infected Texans who are requiring hospitalization — is a benchmark he’s closely monitoring. He cited it as an encouraging metric as the state’s stay-at-home order expired at the end of April.

In Houston, Dallas and other areas that have seen increased hospitalizations, “we need to drill down and find out exactly why that is,” Abbott said.

Yeah, I’m closely monitoring the hospitalization rate, too. We’re now at three straight days of record numbers there, for those of you playing along at home. It’s happening locally, and it’s mostly been happening since Memorial Day. I’m going to keep asking the same question I have every time I do one of these posts: What’s our plan for when we start getting into the “dangerously full” zone for hospitals? If it turns out to be localized rather than everywhere in the state, will Greg Abbott let local leaders have more discretion to take action as they had back in March? I really really hope it doesn’t come to that, but hope seems to be all we’ve got.

UPDATE: From the Trib: “Texas reports largest single-day increase in coronavirus cases”. Insert shrug emoji here.

The local view of COVID hospitalizations

More numbers.

Three weeks after it stood out as the urban exception to the state’s spiking COVID-19 crisis, the Houston region has begun seeing a significant increase in cases and hospitalizations.

The upturn, which began two weeks ago and accelerated this week, comes a month after Gov. Greg Abbott began allowing businesses to reopen and a week and a half after the Memorial Day weekend, both of which health officials think led people to let their guard down and come into closer contact with others. The hike followed a roughly month-long plateau the area had settled into.

“This is a trend we’re definitely keeping an eye on,” said Harris County Judge Lina Hidalgo. “If the numbers keep up in this direction, we could be headed to a place where we run out of hospital space, which obviously would be a problem.”

COVID-19 patients have occupied hospital intensive-care units in the nine-county Houston area at higher levels the first three days in June than they did on any single day in May, according to date compiled by the Southeast Texas Regional Advisory Council, a state group that coordinates the region’s emergency response to disasters. In Harris County, hospital admissions have increased at statistically significant levels the past two weeks.

[…]

Despite public health admonitions reminding people of the need to continue practicing social distancing, many didn’t seem to get the message, said public health officials.

“I am afraid the public interprets lifting ‘government-mandated shelter in place” and closure of non-essential business that the pandemic is over and community and individual mitigation measures are no longer necessary,” said Gerald Parker, director of the pandemic and biosecurity policy program at Texas A&M’s Bush School of Government Service. “But the virus is still in our communities and can hit the most vulnerable hard.”

Parker, who said “time will tell whether or not the increase in case becomes dangerous,” urged people to still wear masks, limit numbers in gatherings and maintain six feet of separation from others.

See here for the state view. Again, this may wind up being a small and temporary bump, and it may be that we have the capacity to absorb the increase with no problems. (If you don’t consider the larger number of people getting and dying from this virus a problem, I suppose.) But again my question is, what happens if we can’t handle it? What happens if the hospitals do begin to become overwhelmed? What’s our plan at that point? To be more specific, what if it’s just a problem here in Harris County? Will Judge Hidalgo have the authority again to impose a stay-at-home order, or are we all at Greg Abbott’s mercy? (Not to mention the whims of the State Supreme Court.) What we have now looks like hope and not a plan. And I hope I’m wrong about that.

So how’s that reopening going?

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?

We still have no idea how many people have been infected

There’s just a real lack of testing being done.

Six times in three weeks, Marci Rosenberg and her ailing husband and teenage children tried to get tested for the new coronavirus — only to be turned away each time, either for not meeting narrow testing criteria or because there simply were not enough tests available.

All the while, the Bellaire family of four grew sicker as their fevers spiked and their coughs worsened. They said they fell one by one into an exhaustion unlike any they had felt before.

By March 18, Rosenberg was desperate and pleaded with her doctor for a test. Dr. Lisa Ehrlich, an internal medicine physician, told Rosenberg to pull into her office driveway. But Ehrlich warned Rosenberg, “I can only test one of you.” She swabbed her throat through an open car window. The result came back the next day: positive.

The rest of her family was presumed to be positive but untested – and thus excluded from any official tally of the disease.

As the number of confirmed cases of the potentially deadly virus continues to explode across the Houston region – tripling from 1,000 to more than 3,000 in just the past week – there is mounting evidence that the true scope of the disease here could be far worse than the numbers indicate.

A Houston Chronicle analysis of testing data collected through Wednesday shows that Texas has the second-worst rate of testing per capita in the nation, with only 332 tests conducted for every 100,000 people. Only Kansas ranks lower, at 327 per 100,000 people.

In cities across Texas — from Houston to Dallas, San Antonio to Nacogdoches — testing continues to be fraught with missteps, delays and shortages, resulting in what many predict will ultimately be a significant undercount. Not fully knowing who has or had the disease both skews public health data and also hampers treatment and prevention strategies, potentially leading to a higher death count, health care experts say.

[…]

As the pandemic’s march quickened, Texas was slow to ramp up testing.

The first confirmed case in Texas, outside those under federal quarantine from a cruise ship, was March 4, striking a Houston area man in his 70s who lived in Fort Bend county and had recently traveled abroad. By month’s end, the Houston area had more than 1,000 confirmed cases. A week later, the number had pushed past 3,000.

Yet it was not until March 30 that the rate of testing per 100,000 people in Texas topped 100. As of Wednesday, the state was testing 327 per 100,000, according to a Chronicle analysis of data from The COVID Tracking Project, which collects information nationwide on testing primarily from state health departments, and supplements with reliable news reports and live press conferences.

Twenty-six states in the U.S. are testing at least double the number of patients per capita as Texas, in some cases six times more. New York, for instance, is testing 1,877 per 100,000 people while neighboring Louisiana is testing 1,622 per 100,000. Even smaller states, such as New Mexico, are testing triple the rate of Texas.

Texas officials defended the state’s response.

“We’ve consistently seen about 10 percent of tests coming back positive, which indicates there is enough testing for public health surveillance,” said Chris Van Deusen, a spokesman for the Department of State Health Services, in an email, “If we saw 40 or 50 percent or more of test coming back positive, we’d be concerned that there could be a large number of cases out there going unreported, but that has not been the case.”

It is unclear if that is a reliable measure. Nearly 41 percent of New York tests were positive, the second-highest rate in the country. In Texas, about 9.4 percent of tests were positive — roughly the same as Washington state, where one of the largest outbreaks of coronavirus has occurred.

Not the first time we’ve talked about this, and it won’t be the last. This also means that the official number of deaths attributed to coronavirus is likely too low. This has been the case globally, especially in the hardest-hit places, where the difference between the normal daily mortality rate and the observed mortality rate during the crisis is a lot bigger than the official count of COVID-19 deaths. The good news is that as yet our hospitals have not been overwhelmed, but we can’t say with confidence that that will continue to be the case.

The number of people hospitalized with COVID-19 in the Houston area is continuing a steady climb, not close to crisis levels but unnerving enough that experts still aren’t sure when the area’s grand experiment in social distancing will start showing up in daily counts.

After a week in which COVID-19 hospitalization numbers more than doubled in Harris County, epidemiologists and infectious disease specialists said it likely will be another week to 10 days before they know if the stay-at-home orders and closures are reducing the rate at which the coronavirus is spreading and keeping health care facilities from being overwhelmed.

“Even though we’ve been social distancing for three weeks, it’s too early to know when we’ll be on the downward slope,” said Catherine Troisi, a professor of epidemiology at UTHealth School of Public Health. “The numbers we’re seeing now reflect people who were exposed to the virus up to four weeks ago.”

Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital, said the social distancing has paid off in terms of keeping hospital volumes under control so far but added that the pay-off in terms of ending the pandemic is unclear. He said that “we need to continue stay-at-home orders until the end of the month, then reassess whether to extend them longer.”

Hotez and others said that aggressive social distancing is more important now than ever, given modelers are projecting that the number of COVID-19 cases in the Houston area should peak in the next few weeks. They said people venturing out during the peak period will put themselves at high risk of contracting the virus.

[…]

The study, released on March 24, originally said the virus’ spread in the Houston area would peak April 7 and burn out by mid-May if stay-at-home orders are continued until May 12. It was not clear Tuesday when the study projects the virus will burn out now.

Eric Boerwinkle, the lead researcher, could not be reached for comment Tuesday and UTHealth officials had no update on the study. Boerwinkle, who did not make the original modeling publicly available, has briefed top local government officials on the work.

Another modeling study, conducted by the University of Washington’s Institute for Health Metrics and Evaluation, now projects that the Texas peak use of hospital resources for COVID-19 will be April 19, some two weeks earlier than it previously projected. The study, reportedly relied on by the Trump administration, foresees no bed shortage in the state, including in intensive care.

“That’s why you shouldn’t place too much weight on any one model,” said Dr. James McDeavitt, Baylor’s dean of clinical affairs. “They depend on assumptions plugged in and can show everything from Houston being able to handle the surge to a New York City-like situation.”

McDeavitt noted the wild cards that go into modeling — the number of people admitted to a hospital, the percentage that need intensive care, how long it takes to get patients off ventilators, how long they need to recover in a regular bed once they move out of intensive care. Those are the assumptions that drive models, he noted.

McDeavitt said he doesn’t think the number of cases will come down in the Houston area until the end of the month.

That story was from earlier in the week, so all of the numbers are a bit out of date by now. But the bottom line remains that we don’t know where we are on the curve because we don’t really know how many people are or have been sick. Models all rely on data, and we’re also not good with the data.

The information Texans are working with is too damn thin.

Where to start? Not enough tests have been completed, or taken, to really know who has or doesn’t have the disease, where the Texas hotspots are, or whether people who have died of respiratory problems had COVID-19. The relatively small number of test results also means we don’t know which people had the disease and recovered (and how many people have recovered) and whether the projections being made with that skimpy data are accurate enough to guide our public health decisions.

It’s not enough to say that the testing is getting better, that we know more than we knew just a few days ago. What we still don’t know overshadows what we do know.

We’re like pilots flying in clouds without instruments. We know a little bit, but not enough to make really solid decisions or to figure out what’s next. We’re learning as we go. As of Thursday, Texas was reporting 10,230 cases and 199 deaths, 1,439 hospitalized COVID-19 patients and 106,134 tests conducted.

Given the level of testing right now, it’s hard to know how many cases Texas really has. Because the best way to get tested for the new coronavirus is to show symptoms that a medical professional finds troublesome, it’s probably safe to say we’re not testing many people who are carrying the virus but don’t have symptoms.

It’s easier — because it’s more obvious — to map the institutional cases. When someone in a nursing home or a state supported living center or a prison tests positive, testing everyone in that location is simple and smart. It’s simple to figure out that everyone in a given building or campus might have been exposed.

Even that data isn’t always available. The state of Texas initially wasn’t sharing details about the data it has collected from nursing homes where COVID-19 cases have been found. But a few days after The Texas Tribune’s Edgar Walters and Carla Astudillo wrote about it, the state revealed 13% of nursing homes have at least one confirmed case.

We’re doing a lot of flying blind. If we want to make good decisions about things like when and how to restart the economy, we need a much better understanding of where we are, and where that means we’re likely to be going.

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.

Another “when might this peak” projection

From the Current:

A new study suggests San Antonio’s current shelter-in-place order, which runs through April 9, may not be long enough to ride out the worst of the coronavirus pandemic.

Texas is more than a month away from the peak of the crisis, which is likely to hit the state May 2, according to a state-by-state analysis by the Institute for Health Metrics and Evaluation.

The United States as a whole will hit its peak earlier, on April 15. But that’s still days after the Alamo City’s order expires.

May 2 will mark both the date of the virus’ peak drain on Texas’ hospital resources and the state’s highest number of COVID-19 related deaths, according to the IHME, an independent research center at the University of Washington. It made those projections by modeling statistics collected by the World Health Organization and local and national governments.

[…]

Worth noting: the IHME’s modeling assumes the public is practicing strong social distancing and other protective measures. However, it also assumes Texas Gov. Greg Abbott continues not to implement a statewide stay-at-home order and won’t mandate closure of all non-essential services.

After Texas’ potentially devastating peak, the number of deaths and hospitalizations would drop sharply by the beginning of June, according to IHME’s projections. The virus could run its course by early July.

Even so, IMHE expects 4,150 Texans to die from COVID-19 related causes by August 4. It also predicts more than 82,000 nationwide will succumb to the disease by then.

A previous projection done by UT Health scientists suggested that the Houston area could peak in mid-April, with the pandemic burning out in our area by early May. I don’t know much about epidemiology, but I do know that the assumption of when Day 0 is – that is, the day of the first infection – matters a lot, so a variance of even a couple of days could shift things quite a bit one way or the other. Beyond that, I would recommend taking these different studies and projections with the same level of skepticism and trust one would put into an individual poll result: Illuminating and useful, but still just one data point that doesn’t mean as much as it might without confirmation from other results.

With Dr. Fauci’s estimates of 100K to 200K dead nationwide in a best-case scenario, this seems optimistic to me. Maybe it’s better to think of it as a more formal (if not necessarily more precise) quantification of that best case scenario. Note that the numbers given in this projection represent the midpoint of a range of possible outcomes – those error bars are pretty damn wide. Given the uneven implementation of stay-at-home orders and the lack of a statewide order, I’d be prepared for this to end up being well on the low side. But maybe we’ll get lucky. In the meantime, stay at home. TPM has more.

(You can play with the data yourself here. That’s how I generated the embedded image in this post.)

UPDATE: This Twitter thread from Carol Bergstrom, who is an actual expert, explains the concerns with this much better than I can. His interpretation is similar to mine in that this is a “best case” model, but he posits that the “error bars” are the range of uncertainty for that best case model, not for the entire range of possible outcomes. In other words, if the underlying assumption that social distancing isn’t working as well as we hope, or that we’re not doing it well enough for it to work properly, then the range of outcomes we will get will be considerably worse.

The state of the state’s response

I mean, it’s something.

Gov. Greg Abbott took multiple measures Sunday designed to expand hospital staffing and capacity in Texas, but declined to issue a statewide shelter-in-place order — even as calls for such an action increased as the new coronavirus continued to spread across the state.

In an effort to free up hospital beds in anticipation of an influx of patients sick with COVID-19, the disease caused by the coronavirus, Abbott ordered health care professionals to postpone “all surgeries that are not medically necessary” and suspended regulations to allow hospitals to treat more than one patient in a room.

But he did not order all Texans to shelter in place, noting that there are still many counties in the state without confirmed cases and that he wants to see the full impact of an executive order he issued Thursday. In the meantime, he welcomed local officials to take more restrictive action than he has statewide.

During an afternoon news conference at the state Capitol in Austin, Abbott also announced the formation of a “strike force” to respond to the coronavirus and that the Texas National Guard, which he activated several days ago, would be deployed this week to help hospitals deal with the outbreak.

In the lead-up to Abbott’s news conference, though, attention centered most intensely on whether he would go beyond the executive order that he issued Thursday. That order urged all Texans to limit public gatherings to 10 people, prohibited eating in at restaurants and bars and temporarily closed schools. That order went into effect midnight Friday and goes through midnight April 3.

“We need to see the level of effectiveness of the executive order,” Abbott said. “What we may be right for places like the large urban areas may not be right at this particular point of time for the more than 200 counties that have zero cases of COVID-19.”

[…]

Abbott said that his decision not to issue a statewide order should not stop local officials from issuing such orders in their jurisdictions.

“Local officials have the authority to implement more strict standards than I as governor have implemented in the state of Texas, “Abbott said. “If they choose to do so I would applaud them for doing so, but at this time it is not the appropriate approach to mandate that same strict standard across every area of the state, especially at a time when we are yet to see the results coming out of my most recent executive order.”

See here for the background. I can see the reason for Abbott’s actions, or lack thereof. It’s not clear that this is necessary for rural areas, and for the most part the localities that have needed such action have taken it themselves. (Insert reminder about Abbott’s self-serving relationship with the concept of “local control” here.) Indeed, the next story the Trib ran is about Dallas County prepping a shelter-in-place order. (Harris County Judge Lina Hidalgo has said she is considering such an order but has not yet announced one.) At least some hospitals have already acted to limit or suspend elective procedures as well. What all of this does is mostly make me think that Abbott is behind the curve rather than ahead of it. You know I don’t think much of our Governor, but even for him this seems kind of limp. What could he be doing that isn’t already being done? That’s what I’d like to know.

Does Houston have enough hospital capacity?

We sure hope so.

Houston-area hospitals would not have enough resources to respond to a widespread outbreak of the coronavirus unless they take strong action to significantly increase capacity, according to new calculations released by Harvard University.

Even in the most conservative of three outbreak scenarios that it created, the Harvard Global Health Initiative found that Houston-area hospitals would lack the necessary beds to care for all patients in need of hospitalization. In a worst case scenario, it would need four times the number currently available in the region.

In the middle scenario — if 40 percent of adults contract the virus over a 12-month period and a fifth of them require hospitalization — more than 430,000 people would be hospitalized in that time. That would require 14,300 beds on an average day, nearly three times the estimated number currently available in Houston.

“We simply do not have enough hospital capacity to assume all of those people,” Harris County Judge Lina Hidalgo said last week, assuming 30 percent of county residents were to become sick at the same time. “We can’t afford to have a sudden spike in cases.”

The Harvard initiative data, taken from what’s known as a modeling exercise, don’t constitute predictions so much as they provide scenarios that hospital and policymakers can take into account in planning for a possible surge of the epidemic of COVID-19, the respiratory disease caused by the coronavirus. The data was produced at local hospital market-specific levels because “how many beds are available in Boston is irrelevant to a person in Utah,” said Ashish K. Jha, director of the institute.

The study, released Tuesday, modeled nine scenarios. The scenarios use infection rates of 20 percent, 40 percent and 60 percent and outbreak spans of six, 12 and 18 months.

A 20 percent infection rate over 18 months would mean fewer people caught COVID-19 than fell ill to the flu last year, according to an analysis by ProPublica. Previous studies have suggested the virus is more transmissible than the flu.

The study assumes that hospitals will not free up occupied beds by delaying elective procedures or sending people home early. It also assumes hospitals will not add beds.

[…]

The Harvard calculations were criticized by some policy experts and doctors, who said not enough is known about the spread of COVID-19 to make meaningful assumptions.

“It’s incredibly hard to (make) projections about what’s going to happen because this is a unique first-time event and we have so little data,” said Vivian Ho, a Rice University health economist. “Because we don’t have that much testing, we do not know how quickly it’s spreading, what percent of cases are serious, if we can target hot-spot areas and essentially shut them down.”

Ho added, “I hope there’s something wrong with their assumptions because if not, we’re doomed.”

I’m not an expert, but I do know that Houston hospitals are in fact now suspending elective procedures, so that should help. I have hope that all this social distancing we are doing will help, too. Beyond that…man, I don’t know. I can’t wrap my mind around the possible bad outcomes we may face. I have hope because the other options are just too grim.

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.

The robot nurse

We are living in the future, for better and for worse.

https://www.instagram.com/p/B01H56Fn8_0/

A friendly one-armed, bright-eyed robot is roving the hallways of Medical City Dallas’ Heart and Spine hospitals, helping nurses with routine tasks that previously took time away from patient care.

Nicknamed Moxi and regarded as one of the staff, the robot is equipped with sensors to help it navigate, and even anticipate people’s movements, as it travels across hospital floors. Medical City Dallas partnered last fall with Austin-based artificial intelligence firm Diligent Robotics Inc. to become the first North Texas hospital to employ a robot full time in a clinical setting.

“When we were opening up the hospital back in October, one of the things we wanted to really focus on was being an innovation center and bringing new technology to the health care setting,” Medical City Chief Operating Officer Josh Kemph told The Dallas Morning News.

When a nurse is interacting with it in a way that would normally trigger an error message, Moxi instead emits pleasant beeps and chirps to notify them. Some patients even have their own names for the assistant, which has its own Instagram account run by Diligent.

But Moxi is so much more than just a pretty face.

Texas will face a shortage of more than 71,000 nurses by 2030, according to the Texas Health and Human Services Commission. And with the demand for nurses expected to only continue increasing, Medical City Dallas director of surgical and procedural services Stefanie Beavers says she hopes it will also make it easier for the hospital’s existing workforce to optimize their day-to-day work.

“This really offers health care facilities an opportunity for the nursing workforce to focus on patient care and be directly at the bedside versus taking them away, and allowing their time to be truly dedicated to patient care tasks,” Beavers said.

It never crosses the threshold into patient care, instead delivering things like blood samples back and forth to a lab and updating patients’ medical records instantaneously for hospital staff.

“She’s really meant to be a team member that’s supporting you in the background,” Beavers said.

For now, at least, Moxie is a modern version of the FBI mail robot, which does simple drudge work like delivering specimens and allowing the human nurses to do more important things. It’s also a lot cheaper to employ than human nurses, or human nurses’ aides, and in the way of driverless cars, it’s just a matter of time before they have the capability to cross that threshold into patient care. That may be 20 or 30 years down the line, but it’s out there somewhere. I just hope we can have a productive conversation about what that will mean for the rest of us before it happens.

Medicaid and hospitals

I have three things to say about this.

A proposed change in Medicaid rules could cost Texas hospitals billions of dollars, forcing many to cut services and some rural hospitals to close their doors, health care industry officials said.

The change, aimed at increasing the transparency of how the program’s money is spent, narrows the definition of state and local funds that can be used to determine federal matching funds. That, in turn, would reduce federal funding and cost Texas hospitals an estimated $11 billion a year, industry officials said.

Houston hospitals would lose an estimated $500 million a year, said Tim Ottinger, director of governmental relations at CHI St. Luke’s Health.

A drop in funding would mean extreme hardship for many of Texas’ rural hospitals, which stand to lose some $900 million a year. The Texas Organization for Rural and Community Hospitals (TORCH) found that 46 percent of the state’s rural hospitals operate at a loss. Over the last decade, 26 rural hospitals have closed in Texas, the highest rate in the nation.

It’s unclear how many more rural hospitals could close if the proposed rule goes into effect as written, but it would be devastating to pull so much money from their budgets, said John Henderson, president of TORCH.

“A business can’t survive,” Henderson said. “But this isn’t just a business, it’s a service.”

1. I mean, you’d think that a policy that would cost the state billions of dollars and would have such a negative impact on rural areas, where access to health care is already severely lacking, would call for some kind of response from our state government. Turns out they like it, because they say it would let them cut costs. Just in the state budget, though. Counties and hospitals and the rest are on their own.

2. That said, some of those rural communities don’t seem to be too concerned about their hospitals. So maybe I shouldn’t be all that concerned on their behalf.

3. Of course, this proposed change will not survive the end of the Trump administration. None of the Democratic Presidential candidates, whatever their health care plans are, will allow this to stand. So, you know, make sure you vote for one of them this November.

Maybe rural counties don’t want hospitals

That’s what the evidence says.

The voters of Fayette County have spoken, and they’ve said that they don’t need a hospital in this rural community of 322,000 people, one hour southeast of Austin — or at least not enough to pay for it. In a landslide vote Thursday night, county residents overwhelmingly rejected a proposition to create a taxing district for St. Mark’s Medical Center in La Grange, which would have kept the deeply indebted hospital open for the foreseeable future. As the polls closed, it was clear that the idea of propping up the institution with public money didn’t have a snowball’s chance in Central Texas. The final tally was 1,360 for, 5,600 against.

“I’m very proud of the grassroots effort that stood against the taxes,” Deborah Frank, the chair of Fayette County’s Republican Party and a member of Concerned Taxpayers of Fayette County PAC, told the Observer Friday. Her group swiftly mobilized an opposition campaign against the proposition after it was put on the ballot in April, holding public meetings and distributing yard signs reading “NO NEW TAXES.” Their message: People here are already taxed enough and shouldn’t be forced to bail out a private institution simply because it’s made what they see as bad financial decisions.

Voters apparently took the message to heart.

The resounding loss is expected to push the 65-bed hospital, which is at least $14 million in debt, even closer to financial collapse. And it comes at a time when the headwinds against rural hospitals in Texas are especially strong.

Across the state, roughly 20 rural hospitals have shuttered since 2013 — casualties of low patient volumes, stingy Medicaid and Medicare reimbursement rates, and the burden of operating in Texas, which has more uninsured people than any other state. Seventy-five more are at risk of closing down.

One point to note: I have no idea where that “rural community of 322,000 people” figure comes from. Fayette County had 24,554 people as of the 2010 Census, and while it’s been growing over the past few decades, I’m pretty sure it hasn’t grown that much since then. I don’t live in La Grange and I don’t know anything about St. Mark’s Medical Center, so maybe it was a fiscally sound decision to not try to prop it up with a taxing district. I do know that if I lived in La Grange and faced the prospect having to travel 20 miles to Smithville or 26 miles the other direction to Columbus to find an emergency room, I’d be a little concerned about the risks to my health going forward. But hey, at least their taxes won’t go up.

Now how much would you pay for that emergency room visit?

Guess higher, and it is a guess because who knows what you’ll wind up getting charged for it.

Fifteen months after Texas enacted a law to bring transparency to the state’s for-profit free-standing emergency rooms, many of the facilities continue to send mixed messages about insurance coverage that could expose unsuspecting patients to surprise medical bills.

A Houston Chronicle review of websites representing the 52 free-standing emergency rooms in the Houston area shows a pattern in which many of the facilities prominently advertise that they “accept” all major private insurance. Some even list the insurers’ names and logos.

But often tucked under pull-down tabs or at the bottom of the page is a notice that the facilities are outside the networks of those insurers, followed by a reassurance that under the Texas insurance code, network status does not matter in emergency treatment, implying patients needn’t worry about coverage.

What the websites fail to disclose is that out-of-network status can result in insurance reimbursements far below the charges, leaving patients on the hook for the remainder of the bill — sometimes thousands of dollars.

“The word ‘accept’ means something very different to them than to the consumer, and they know that when they write their websites,” said Stacey Pogue, senior health policy analyst at the Austin-based Center for Public Policy Priorities. “They do not tell the rest of the story.”

For example, many of the Houston-area facilities advertise that they accept Blue Cross and Blue Shield of Texas, the state’s largest insurer. But the Chronicle’s review found that only five — about 10 percent — are in that insurer’s network.

Those findings are consistent with a statewide report by AARP Texas, to be released Monday at a state Senate committee hearing, that found 77 percent of the state’s 215 free-standing emergency rooms said they “take” or “accept” Blue Cross and Blue Shield insurance, but were out-of-network.

Free-standing emergency rooms defend their websites, describing concerns raised by advocacy groups and Texas lawmakers as manufactured outrage.

“I don’t see a problem with saying they ‘accept,’” said Dr. Carrie de Moor, CEO of Code 3 Emergency Partners, a Frisco-based network of free-standing emergency rooms, urgent care clinics and a telemedicine program. She insisted that patients understand that accepting someone’s insurance is different from being in that company’s network.

It may seem like a hair-splitting distinction, but it can carry high costs, health policy experts said.

Obvious point #1: It’s ridiculous that we live in a society where basic medical needs, including emergency care, are not met. It’s utterly scandalous that prior to the Affordable Care Act, there were thousands upon thousands of bankruptcies caused every year by medical issues. Plenty of other countries have figured this out. Our standard of medical care is no better than theirs. It’s just more expensive.

Obvious point #2: For those who believe in the power of the free market, why is it that medical services, especially those tied to emergency and hospital care, are so utterly opaque when it comes to their pricing? Think of all the other goods and services you buy. In nearly all of them, you know up front how much it’s going to cost. That is universally untrue for the vast majority of medical services, from basics like painkillers and bandages to anaesthesia and specialist fees to higher-end products like EKGs and colonoscopies. There’s no such thing as a free market with unknowable prices. You want to move towards something like a free market in health care, fix that.

Trumpcare would be a hospital killer

This is hardly a new problem, but it’s yet another aspect of Trumpcare that gets too little attention.

Texas hospitals stand to lose billions under the Republican-backed health plan, as federal Medicaid dollars shrink, leading to a rise in uncompensated care, according to a new analysis by the Commonwealth Fund, a national health policy foundation.

The study looked only at the U.S. House plan passed last month. It has not yet examined the impact of the U.S. Senate’s version unveiled late last week, which experts have predicted will bring even deeper cuts to Medicaid.

In Texas, uncompensated costs in the state’s 304 acute care hospitals could increase by 7 percent, rising to $38.4 billion over the next decade, the study found.

That compares with an estimated $35.8 billion over the next decade under the current Affordable Care Act.

At issue is a spike in the number of the nation’s uninsured whose care is often absorbed by hospitals. As many as 23 million Americans could become uninsured over the next decade under the House bill because of cuts to Medicaid, and the recalculation of insurance plans and how people afford them, the Congressional Budget Office estimated late last month.

[…]

Texas already leads the nation in the number of uninsured and hospital executives have cautioned that their institutions would be hard pressed to take a bigger hit should the uninsured rate go higher.

“If people think Harris Health can absorb this, that is a miscalculation,” said George Masi, president and CEO of Harris Health System, in a January interview with the Chronicle.

This is basically what the world was like before the Affordable Care Act. People who had no insurance would use hospital emergency rooms for care when they really needed it, which is inefficient and dangerous and super expensive and many other negative things, all of which get picked up by local taxpayers. There are so many things that are wrong with and bad about the GOP’s “health care” plan that it’s hard to focus on any one thing and even harder to prioritize, but this one is really big. And it will hurt rural areas at least as much as urban areas. Not that the Republicans who represent rural areas care, and it’s not clear that the voters who would be affected have figured it out, or if they have if they’re capable of getting past their faith in the Charlatan in Chief. But the facts are stubborn things. The Rivard Report has more.

Rural hospitals

If this story was meant to evoke my sympathy, I’m afraid it failed.

It's constitutional - deal with it

It’s constitutional – deal with it

Since the hospital closed in Paducah, a town 30 miles to the north, patients in Guthrie have 60 long miles to travel to Childress for care. It’s a feeling of isolation that has crept up on other rural corners of the state following a spate of 10 hospital closures in the past two years. And financial data collected by the state and federal government shows revenue is falling for other rural hospitals, suggesting more may be on the brink.

Policymakers, operating on tight budgets, must decide whether they are willing to spend more money on small hospitals serving a limited number of patients, hospitals that in most cases could not keep their doors open without government assistance. But without them, people, inevitably, will die.

“We’ve all seen the crash that’s coming in the next five years,” said Kell Mercer, an Austin-based lawyer who has worked on hospital bankruptcy cases. “The Legislature’s more interested in cutting revenue and cutting services than providing the basic services for these rural communities. This is a perfect storm of events that’s going to hit the state, hard.”

Texas’ rural hospitals have long struggled to stay afloat, but new threats to their survival have mounted in recent years. Undelivered promises of federal health reform, payment cuts by both government programs and private insurers, falling patient volumes and a declining rural population overall have been tough on business — a phenomenon one health care executive called “death by a thousand paper cuts.” Add to that Texas’ distinction as the state with the highest percentage of people without health insurance and you get a financially hostile landscape for rural hospital operators.

“Hospital operating margins, and this is probably true of the big guys and the small guys, too, are very small, if not negative,” said John Henderson, chief executive of the Childress Regional Medical Center. “In a way, Texas rural hospitals are kind of in a worst-case scenario situation, because we lead the nation in uninsured, and we took Medicare cuts hoping that we could cover more people.”

[…]

The sum of all these changes has people like Don McBeath, who lobbies for rural hospitals, warning of a repeat of the widespread hospital closures Texas experienced three decades ago. In 1983, the federal government restructured the way Medicare made payments to hospitals, meant to reward efficient care. Those changes proved untenable for small hospitals with low patient volume, heralding decades of closures that claimed more than 200 small Texas hospitals as casualties, McBeath said.

Some counties can afford to raise taxes to keep their hospitals open; others cannot, or find that raising taxes is politically impossible.

And when a small county hospital closes, often the hospital in the next county over must shoulder a bigger burden of uninsured patients. Even patients with insurance face higher deductibles and often can’t pay their bills.

“When it closes, you’re forced to make other decisions, other plans,” said Becky Wilbanks, a judge in East Texas’ Cass County, which saw a hospital closure last year. “That’s an economic hit that we took.”

Rural hospitals are often one of the biggest and highest-paying employers in a community, Wilbanks said.

And when they close, it can have a domino effect on other local businesses, said Hall County Judge Ray Powell. When his county’s hospital closed in 2002, it prompted the local farm equipment dealership to close its doors and move to Childress.

“It was a big loss,” he said. “It was devastating.”

Across Texas, rural counties are seeing their populations dwindle. King County, home to Guthrie, is one of Texas’ 46 rural counties that are projected to lose population over the next four decades — at a time when the rest of the state’s population is expected to double.

Maybe I’m just a jerk, but my first reaction to stories like this is to check the most recent election results in the counties named.

In Cass County, Greg Abbott got 74.64% of the vote.
In Hall County, Greg Abbott got 85.09% of the vote.
In King County, Greg Abbott got 96.77% of the vote. Ninety-three people voted in total, and 90 of them went for Abbott.

In other words, the voters in these counties have gotten what they voted for. Perhaps someone should point that out to them if and when more of these rural hospitals close.

This isn’t entirely fair. Declining population in these counties is nobody’s fault. A change in Medicare payments in 2002 caused a lot of upheaval. But the problems they’re facing now are entirely the result of Republican intransigence on Obamacare and hostility to Medicaid. It’s abundantly clear by now that Medicaid expansion has been a boon for the states that have done it, while states like Texas are feeling the downside good and hard. If you want to blame Wendy Davis for not adequately communicating the issue to these voters, you have to equally blame Greg Abbott for continually lying about the need for “freedom” from the “tyranny” of Obamacare. Elections have consequences. This is one of them.