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The empty “mental health” promise

What’s going on in Uvalde these days.

Days after the May 24 shooting, Texas Gov. Greg Abbott promised an “abundance of mental health services” to help “anyone in the community who needs it … the totality of anyone who lives in this community.” He said the services would be free. “We just want you to ask for them,” he said, before giving out the 24/7 hotline number — 888-690-0799.

That’s a tall order for a community in an area with a shortage of mental health resources, in a state that ranks last for overall access to mental health care, according to a 2022 State of Mental Health in America report.

Mental health organizations are assembling a collection of services to assist those who seek help in Uvalde. But there have been hiccups and hitches along the way.

There is worry that what’s being offered is not coming together as fast or efficiently as it could be, and that it’s being assembled without keeping in mind the community it serves: Many residents are lower income, and some may have difficulties with transportation, or are mainly Hispanic. Many are not accustomed to seeking out therapy, or are distrustful of who is providing it.

Quintanilla-Taylor didn’t believe many would use the mental health services and had doubts about their long term availability.

“It’s not going be prevalent. … I don’t trust the resources, and that’s coming from an educated person,” said Quintanilla-Taylor, who’s pursuing a doctorate in philosophy and specializing in organizational leadership at the University of Texas at San Antonio.

[…]

Uvalde County Commissioners, the countywide government body, voted Thursday to purchase a building to create the Uvalde Together Resiliency Center to serve as a hub for long-term services, such as crisis counseling and behavioral health care for survivors.

Abbott set aside $5 million in funding for the center, which has been operating at the county fairgrounds.

Texas Sen. Roland Gutierrez, whose vast district includes Uvalde, said the community needs continuity of care and rather than create a new building the state could invest in the existing local community health clinic, in operation for 40 years and already serving 11,000 uninsured Uvalde residents.

“These are people who have behavioral health on the ground. They actually have the one psychiatrist in Uvalde right here,” Gutierrez said Friday referring to the clinic. “We needed to have the budget so that we can bring in therapists, which we would have been able to do with that money. Instead, they’re starting from whole cloth this promised center you’re going to have the district attorney run?”

Gutierrez, who has shifted a district office from Eagle Pass to Uvalde, said he met with 11 families whose children survived the shootings and were either wounded or sent to the hospital.

“What the families have been telling me is they don’t want to see one therapist one week, a different one the following and another one yet maybe the next week,” he said. “So, they are having trouble with appointments, with continuity and that’s very, very important, especially when we are talking about young children.”

Gutierrez said he sent a letter to Abbott asking for $2 million for the existing free community clinic to provide crisis care but has not heard back.

I’ve discussed this before, and this is another illustration of the problem. We can count on hearing two things whenever there’s a mass shooting in Texas. One is the usual blather about guns and why restricting access to guns isn’t the answer. The other is a rush to talk about mental health, both as a means of explaining the shooter’s actions and now more regularly as an alternate mitigation for gun violence that doesn’t restrict access to guns. It was a big component of the Cornyn bill, and may have been a key to its passage since there’s no question that more mental health services and funding for those services are badly needed. I’m happy to see that happen, it’s just that we all know this is only one piece of a much larger puzzle.

From the state perspective, any and all talk of mental health and services for mental health that comes from our state leaders is guaranteed to be little more than hot air. We have the longstanding issue of healthcare in general being out of reach for too many people because of lack of insurance, and the continued resistance to expanding Medicaid, which would be the single biggest step forward in that regard. We have the also longstanding issue of healthcare in rural areas, from hospitals closing for lack of funds to scarcity of doctors in rural areas, a problem that was supposed to have been solved by the passage of the tort “reform” constitutional amendment nearly 20 years ago. More recently there was Abbott’s redirection of over $200 million in funds from the Department of Health and Human Services to his never-ending border boondoggle. At every opportunity, the Republican leadership has made it clear that they don’t care about funding healthcare in general, and mental health services in particular. But they are willing to use the promise of mental health services as a distraction when the next crisis hits. That’s where we are now, and where we will be again if nothing changes.

Are we going to raise the COVID threat level again?

Maybe, but not yet.

Coronavirus infections are on the rise across Houston, wastewater tracking shows, even as fewer people seek testing two years into the pandemic.

Four months after the city saw record infection rates caused by the highly contagious omicron variant, new COVID-19 cases are once again climbing, according to data collected by Rice University and the Houston Health Department. The most recent sewage samples show increased viral loads at all but a few of the city’s three dozen wastewater treatment plants.

Citywide, the amount of virus particles detected in wastewater is up 242 percent above baseline, with an overall positivity rate of 14 percent. Both metrics increased by about a third over the previous samples, taken in early May. At the 69th street plant, serving much of the Inner Loop, officials said virus levels are 123 percent above baseline, with a 22 percent positivity rate.

Despite the uptick, health officials do not anticipate raising Harris County’s threat level to the highest level. The county’s threat level is currently set at moderate, signally a controlled level of COVID spread.

“Even though we see positivity rates going up, our hospital rates continue to remain low, said Dr. Erika Brown of the Harris County Health Department.

[…]

New of the rise in viral levels in the wastewater comes days after researchers at Houston Methodist reported new insight into how the omicron variant is mutating in Houston and across Texas.

Researchers demonstrated that two dominant sublineages of omicron have developed “unprecedented numbers” of spike protein mutations, leading to increased transmissibility. The mutations also enhance its ability to evade vaccines and the immune system.

This is a press release about the study in question; it’s from late April, which I’d classify as more than “days” ago, but whatever. The COVID levels in our wastewater continue to rise, but if the hospitals are still not seeing an increase in patients, then the threat level will stay where it is. I don’t know how long we can maintain this balance, but I sure hope it continues.

That press release is worth a read:

“One of the surprising findings in this study was that many mutations with critical roles in immune escape in previous variants of SARS-CoV-2 do not play the same roles in immune escape in omicron, and, in some cases, the effects of these mutations are completely reversed,” said Gollihar, who is the head of antibody discovery and accelerated protein therapeutics in Houston Methodist’s Center for Infectious Diseases. “The virus also appears to be stabilizing itself to allow for more mutations to evade our immune systems.”

He said this study is the first to systematically dissect each of the omicron mutations across the entirety of the spike protein. Previous studies miss contextual and long-range interactions across the protein.

“We developed a comprehensive map showing various mechanisms of immune escape by omicron that allows us to identify which antibodies retain neutralization activity against the virus,” Gollihar said. “This and future work will enable clinicians to make informed decisions about the use of monoclonal antibody therapy and aid in the development of next-generation vaccines.”

Having this new information about key features of omicron’s spike protein mutations and how they synergize, Gollihar and his team say it’s possible that the continuing accumulation of mutations may set the stage for greatly altering the equilibrium and stability of the spike protein in a way that allows for new, more virulent strains to develop. Understanding this evolution is critical, they say, to better inform future therapeutic targets and vaccine formulations, as the SARS-CoV-2 virus will continue to evolve with new variants inevitably arising and spreading.

Looking forward, they add, the strategy used in this study also will be applicable to future zoonotic outbreaks and other microbial pathogens, providing a powerful platform for investigating evolutionary trajectories of infectious agents and engineering appropriate and adaptable vaccines.

“We will continue to monitor the virus for changes in the spike protein and add new antibodies to test as they are discovered. Continuing to do so will allow us to design better probes for antibody discovery in hopes of engineering new therapeutics by finding potent neutralizing antibodies across all variants,” Gollihar said. “We have also recently expanded the platform to other pathogens where we hope to stay ahead of other potential outbreaks.”

I’m in awe of the work these folks have done and continue to do – I’m speaking of the researchers worldwide, not just these specific ones. We’re in a constant race with this virus, and so far we’ve been able to keep up. As above, I sure hope that continues, too. Stace has more.

Checking in again on the wastewater

COVID levels keep creeping up.

After the U.S. death toll from COVID-19 hit 1 million deaths on Monday, new data shows numbers on the rise again.

The latest Houston Health Department wastewater results from May 9 show levels are now higher than they were in July of 2020.

The viral load on May 9 was 127 percent higher in comparison to July 6, 2020.

The July 2020 readings serve as a baseline for wastewater testing, since that was during the summer surge of cases.

The positivity rate in Houston is also now at 8 percent. At the end of March, Houston’s wastewater positivity rate was 2 percent.

Since the results are delayed, levels are likely higher now.

Houston Methodist is also reporting a rise in cases over the last two weeks.

[…]

“We have also seen our first cases of BA.4 and BA.5, which we will continue to monitor, since literature suggests these variants escape immunity from previous Omicron infection,” [Dr. Wesley Long of Houston Methodist] tweeted. “Vaccines are still our best defense against COVID-19 along with masking and distancing.”

Long also says while the wastewater levels are nearly 30 percent higher than the July 2020 surge, that the public shouldn’t be fearful, but shouldn’t ignore the trend either.

“The bottom line is, the amount of virus in the community is going up,” Long said. “That’s one thing we know for sure. I wouldn’t be worried, but I would be paying attention.”

There was a story in the Sunday print edition of the Chron about the Houston wastewater tracking, with a byline from the NY Times, but I could not find it online. Note that this KHOU story reports on the May 9 virus level in two different ways, saying that the viral load is “127 percent higher” and also that it is “nearly 30 percent higher”. The latter is correct – the Houston COVID dashboard says that the COVID load is “127% in comparison to the July 2020 level”, which is to say up 27%. Pay attention in those math classes, people.

At this point, until there is a new type of vaccine, we have what we’re going to get. I heard on the CityCast Houston podcast that the vax level in Harris County is about 67%, which is better than it used to be but still too low to really slow things down. What we can do is whatever we can to get the unvaxxed people in our lives to get the shots, and we can get boosted – one if we’re under 50, two if we’re over. Get your kids boosted, which also very much means getting them vaxxed in the first place – only about 30% of kids in this range have had two shots, which is just madness to me. Wear your masks when in indoor public places again, and avoid needless indoor public gatherings. You have to take care of yourself now, so do it. Until it gets worse – and I still hope it won’t – this is the best you can do.

UPDATE: The May 16 numbers are now on the dashboard, and they show that we are at 170% of the July 6, 2020 level. Not great!

Time once again for Texas hospitals to struggle financially

I feel their pain, but…

More than $3 billion in federal money has flowed to Texas health care providers in recent months to help pay for COVID-19 treatments, tests and vaccines for patients without health insurance, according to national health officials.

Of that, a tiny fraction — some $2.2 million — went to the local independent hospital in rural Titus County for treating patients during wave after overwhelming wave of the devastating virus in an area where 1 in 3 residents are uninsured.

But the 174-bed Titus Regional Medical Center in northeast Texas needed every penny it could get as it struggled to cover the sudden, skyrocketing expenses of the pandemic: paying staff competitive wages to keep them on the job, keeping up with federal safety rules and managing record-breaking numbers of patients pouring into in the intensive care unit from a 150-mile radius, said CEO Terry Scoggin.

Now, after sending some $19 billion to hospitals and other health care providers nationwide, the fund known as the Health Resources and Services Administration COVID-19 Uninsured Program — created to help hospitals like Titus Regional pay for the care of uninsured COVID patients — has dried up.

While the halting of funds comes as Texas has seen infection numbers fall dramatically, the virus is still largely uncontrolled, causing surges and lockdowns in other countries. In the past, those surges abroad have always occurred before new cases rise again here in the United States, including Texas, which has more uninsured residents than any other state.

The failure to renew the program in time to continue reimbursing providers means that hospitals, clinics, private practices and others that don’t get public health funding from the state will have to “eat the cost” if they don’t charge for COVID-related services, Scoggin said.

“It’s a huge issue for us because we have so many adults who are uninsured,” Scoggin said. “And so it was kind of a kick in the gut for us when they shut that program off because I thought it was a good use of funds for the COVID piece.”

Refusing care to those patients who can’t pay is not an option, legally or morally, he said.

“We can’t turn people away, so we’re still going to pay for it,” Scoggin said. “It just shifted the expense of the uninsured from federal funds to individual hospitals.”

We’ve discussed the financial straits of rural hospitals in Texas before. I am once again pointing out that the locale in which this story is sited, Titus County, is yet another place that votes heavily Republican – Trump and Cornyn in 2020 and Abbott and Cruz in 2018 all topped 70% of the vote. I continue to have empathy for the employees of these hospitals, who for all I know may be habitually voting for politicians whose stated policy preferences are to help them. But I’m also saying it would be nice for these stories to include that easy-to-look-up data, because the simple fact is that if the likes of Greg Abbott or John Cornyn wanted to help the Titus Regional Medical Center, by expanding Medicaid or helping to push through more federal funds for the care of uninsured COVID payments, they could absolutely do so. The dots are just sitting there, waiting to be connected. We should do that.

Are we about to get more COVID in Houston?

We could be.

New data from the Texas Medical Center shows COVID-19 cases have leveled off over the past week, but some trends suggest the Greater Houston area could be on the verge of seeing higher virus spread.

TMC hospitals reported an average of 351 new cases per day during the week of April 18, the same number it reported during the previous seven-day period. The number of new cases does not include anyone who used an at-home test and did not report a positive result.

Those numbers represent a significant decline from last month, when the hospitals were reporting an average of 2,592 new cases per day.

However, the effective reproduction rate – or the average number of people who will be infected by someone with COVID – increased to 1.0 last week, up from 0.82 one week earlier. The rate essentially measures how well collective behaviors like wearing masks and social distancing are slowing the spread of the virus, with any rate higher than 1.0 meaning that spread is increasing.

The amount of virus being detected at the city of Houston’s wastewater treatment plants has also increased to the highest rate since Feb. 7, according to data from the Houston Health Department. Twenty-one of the city’s 39 wastewater treatment plants saw an increase in viral load in samples that were collected and analyzed April 18. By comparison, 16 plants saw in increase in samples collected and analyzed one week earlier.

The TMC’s weekly update also shows new hospitalizations have increased to an average of 59 admissions per day during the week of April 18, up from 42 the week before. TMC hospitals admitted an average of 89 new patients per day last month.

The data isn’t strongly conclusive, but it’s also early in what could be a trend, and as we know with this virus once you really start to see an uptick, it’s already too late. On the other hand, lots of people have COVID antibodies now, and that plus the number of vaxxed people who haven’t had COVID is probably enough to mitigate any crazy spread, or at least to make it less harmful, at this time. But of course there are still plenty of high-risk people out there, and lots of kids haven’t been vaxxed, and no one wants to get even a mild case of COVID. So, you know, stay cautious. You can still wear a mask even if you don’t have to, and you can get that second booster if you’re eligible. It’s never a bad idea to minimize your exposure to this thing. Stace has more.

COVID hospitalizations at a low in the state

Good news (say it with me) for now.

Texas hospitals are treating fewer than 1,000 patients with COVID-19 for the first time in two years. According to the Texas Department of State Health Services, hospitalizations totaled 993 on Sunday. The last time COVID-19 patients in Texas numbered less than a thousand was April 4, 2020, before the state’s initial surge in hospitalizations, which rose to nearly 11,000 by late July that year.

“Less than a thousand [hospitalizations] is a good place to be and this is what we’ve kind of been waiting for and watching really closely,” said Chief State Epidemiologist Dr. Jennifer Shuford.

Fewer people are getting severely ill and needing medical care, said Dr. Shuford, because nearly the entire Texas population has now developed at least some immune response to SARS-CoV-2, the virus that causes COVID-19.

“We expect, based on some antibody studies that we’ve done, that about 99% of our population has some antibodies to COVID-19, either from vaccination or from prior infection.”

Other infectious disease experts are also cautiously optimistic that vaccinations, combined with four waves of widespread infections – the most recent of which was driven by the omicron variant – will help minimize future surges in cases and hospitalizations.

“I do think that the antibody seroprevalence does have something to do with the declining severity of the illness that we’re seeing in terms of decreased hospitalizations,” said Dr. Robert Atmar, an infectious disease expert who teaches at Baylor College of Medicine.

Dr. Atmar said while he was not aware of how DSHS estimated Texas’ overall immune response, the high rate is possible, especially if infection rates for the virus have been under reported.

“It wouldn’t be surprising if a large percentage of the population had been infected and/or vaccinated. 99% just seems high, but it’s certainly not unreasonable that that might be the case,” he said.

I’m just some guy on the Internet, and I also think 99% is a little high. I do agree that between our mediocre vaccination rate and our undoubtedly high infection rate that a lot of people have at least some immunity at this point, and that is keeping the rate low for now. To some extent, as I understand it, this is how a pandemic becomes endemic – there’s enough residual immunity out there to keep infection rates modest and generally tamp down on larger outbreaks. But that surely comes with no guarantees, and the next bad mutation could happen at any time. If we’re lucky, that will either be relatively mild or be mostly stopped by vaccinations, but at this point who knows what could happen. I’ll be getting booster #2 in the near future, and you should be getting whichever booster you can if you haven’t already. It’s still your best bet.

And we’re back to yellow again

Let’s hope it lasts.

Harris County Judge Lina Hidalgo on Thursday lowered the county’s COVID threat level to yellow, signaling a controlled level of cases following the decline of the omicron wave.

The yellow level means COVID poses a “moderate threat” to the public and urges residents to continue to stay vigilant unless fully vaccinated.

Under the yellow or moderate level, unvaccinated residents are encouraged to continue masking and social distancing, while vaccinated residents are encouraged to do the same where required by law.

“My hope is that we are at a permanent turning point of this pandemic,” Hidalgo said in a statement. “But we’ve yet to have a wave where our hospitals don’t get overwhelmed, so we need to tread with caution before we declare victory over this virus.”

As noted, we dropped to the orange level two weeks ago. We were last in yellow in November, for less than a month before omicron moved in. I’m still wearing a mask for the grocery store and other indoor places with lots of people – I mean, I haven’t had a cold in over two years now, so why wouldn’t I? You do you, as long as that means getting vaxxed and/or boosted if you haven’t yet.

The Rodeo is back

Gonna be interesting to see how different it is, if it’s different at all.

And this year, after a one-year hiatus, the rodeo again will be focused on preventing the spread of COVID-19, the virus that abruptly brought the rodeo to a halt nearly two years ago. Masks will be required on public transit to the rodeo’s grounds, where an abundance of hand-washing and sanitizing stations will be positioned throughout. Many concession stands will only accept credit or debit cards instead of cash, and air-filtration systems have been updated to maximize the fresh air flowing inside NRG Stadium and NRG Center.

As the record-breaking omicron surge subsides, rodeo organizers encourage people to follow health and safety guidelines issued by the Centers for Disease Control and Prevention, which recommends that people stay up-to-date on vaccinations and take precaution such as wearing masks in areas of high transmission. People who are feeling ill are encouraged to stay home. More than 100 people a day continue to die of COVID-19 in Texas, with most of those fatalities among the unvaccinated, figures show.

Still, with the pandemic approaching the two-year mark and nearly 64 percent of Texans age 5 and older vaccinated, health experts agree that it’s time for people to return to large events such as the rodeo.

“We are going to have to live with COVID for a while, and I believe that people should be able to establish a new ‘normal’ and enjoy their lives,” said Dr. M. Kristen Peek, interim dean of the school of public and population health at the University of Texas Medical Branch in Galveston. “The Houston Livestock and Rodeo Show is an important part of Houston that people go and enjoy — just do it safely.”

After reviewing the rodeo’s eight-page document containing its COVID health protocols, Peek said the added precautions “look appropriate.” She said she is looking forward to attending the rodeo with her family.

“We will definitely be masked,” she said.

[…]

Now, 66 percent of Harris County is vaccinated with at least the primary series of Pfizer, Moderna and Johnson & Johnson, according to Harris County Public Health. The recent wave likely boosted natural immunity, and the community is equipped to handle the event without a major risk, said Dr. Paul Klotman, president and CEO of Baylor College of Medicine.

“The rodeo is in a big venue, so there’s a lot of ventilation and a big space,” he said. “Relative to other gatherings, this one ought to be safer than others. And if you look at some of the (recent) football games, there haven’t been a lot of big outbreaks.”

Klotman and other experts added a word of caution: the pandemic is not over. Vulnerable populations, such as immunocompromised people, still face a heightened risk of severe illness if infected.

“I wouldn’t be going if I lived with somebody who is going through cancer chemotherapy,” stressed Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor.

See here for some background. I’m mostly okay with this, especially for the outdoor parts of the rodeo. We don’t currently have any plans to go to the fairgrounds, but we’re all vaxxed and boosted, we don’t have any immunocompromised people in our daily lives, and the risk being outdoors is fairly low. Honestly, taking the train to and from the event, which is the only way to go for me, feels a lot more risky just because the trains are always super full during Rodeo times. I’d feel more apprehensive about attending indoor events and the concerts, but if we did we’d be wearing our KN-95s, so it’s no more risky than some other things we’ve been doing. I don’t expect this to become a vector for infection, but by all means exercise as much caution as you want. Don’t go if you don’t feel good about it.

Orange is the new threat level

New again, anyway.

Harris County Judge Lina Hidalgo lowered Harris County’s COVID-19 threat level to “significant” Thursday, signaling the city is emerging from the worst of the omicron wave as infection rates plummet.

Harris County has met all four metrics needed to lower its threat level from red, its highest level indicating “severe risk,” to orange, the second-highest possible threat level. Under orange, officials still recommend that residents minimize all unnecessary contact and avoid large gatherings to stem the spread of the virus.

“The omicron wave hit Harris County very, very hard,” Hidalgo said in a statement. “In fact, only now have our hospitalization rates dropped to levels that don’t immediately threaten the capacity of our healthcare system.”

[…]

The two other metrics that were keeping the county in red — ICU capacity and new cases per 100,000 — have improved in recent days, leading to the downgrade Thursday. The overall percentage of COVID patients in the ICU fell to the county’s threshold of 15 percent, and the seven-day rate of new cases per 100,000 people declined to 83, well below the county’s goal of 100.

Hidalgo encouraged residents to get vaccinated to avoid another “dangerous” COVID spike.

“While we’re moving in the right direction, there are no guarantees we won’t see another wave in the future,” Hidalgo said.

We were last at orange in December, on the way to red a couple of weeks later. At this rate, we’ll likely be back to yellow soon, and after that who knows. The good news is that between our vaccination level and the sheer number of people who contracted omicron, our overall immunity level for the short term is as good as it’s ever been. The bad news is that our vax level is still way too low, far too few kids have been vaxxed, and the waning omicron wave is causing fewer people to get vaxxed now because the threat is receding. It really is just a matter of time before we’re back in a crisis situation again. If we’re lucky, and we make a strong effort to get a lot more people vaccinated in countries that have not had nearly enough vaccine supply, then maybe that next wave is farther off. If not, well, I probably don’t have to tell you what that means. Stace has more.

The wastewater is once again in our favor

But there’s still a lot of room for improvement.

The latest samples of Houston’s flushed wastewater show diminishing traces of COVID-19 across the region — a promising sign that the highly contagious omicron variant is in retreat.

Hospital admissions are down. Fewer people are testing positive for the virus. And now, the amount of coronavirus in the sewage is falling at all but two Houston wastewater treatment plants. Samples taken from across the city show the virus is no longer proliferating as quickly as it was earlier in the omicron outbreak.

After rising to “unbelievable” heights with omicron’s arrival just weeks ago, the city’s viral load is now falling rapidly, said Loren Hopkins, chief environmental officer at the Houston Health Department.

The level of COVID present in the city’s sewage is now about one-third of that measured at the onset of the omicron peak in late December and early January.

“We had this huge rise to levels we had never seen before,” Hopkins said Wednesday afternoon. “It went up very fast and has been dropping very fast.”

But while the variant may be loosening its grip, levels of the virus remains high. According to sewage testing, there is about as much COVID circulating citywide now as there was during the post-holiday surge a year ago that sickened Houston residents by the thousands and overwhelmed area hospitals.

See here for more on the wastewater tracking project. This metric is in line with other data, but please note what that last paragraph says. I expect this trend to continue, but it’s not far enough down yet that if it were to hit a floor we’d be content with it. Please do continue taking all reasonable precautions. You can see that lovely COVID-in-the-wastewater dashboard here.

Omicron on the decline in Houston

Some good news.

Omicron is receding in the Houston area, new data show, even as hospitals continue to feel the strain of January’s post-holiday bump in COVID-19 cases.

The region’s rate of transmission — a key metric used to gauge how likely an infected person is to spread the virus to others — fell for the third week in a row, health officials reported Monday, fueling hopes that omicron may be on its way out.

The COVID transmission rate across the Houston area was 0.74 last week, meaning the average person who had the virus gave it to one person or less, according to the Texas Medical Center. Spread has remained below 1.0 for two weeks, reflecting omicron’s loosening grip.

New hospital admissions also fell, an encouraging sign after an explosive surge that pushed Texas emergency rooms and intensive care units closer to capacity than at any time during the pandemic. About 2,300 people were hospitalized for COVID in the nine-county region around Houston on Sunday, down 20 percent from two weeks ago.

Houston averaged fewer positive COVID tests last week relative to the mid-January peak. Around 5,400 people tested positive for the virus each day in the greater Houston area, 60 percent as many as the previous week, when the region averaged 9,000 new cases daily, according to TMC data.

That’s good, and it’s consistent with other reporting. We could sure use a bit of a breather. That said, and as the story notes, hospital ICUs are near capacity, and there’s no reason to believe this wave will be the last wave. We still need to get a lot more people vaccinated and boosted. At least on that note, there’s a little more good news.

Earlier this month, Ipsos conducted surveys in Italy and France to gauge the support levels among the populations there for the tough new vaccination mandates that were just introduced. The polling firm shared the data exclusively with Fortune, and the findings surprised not only the pollsters, but also Fortune readers.

As a result, Fortune asked Ipsos to expand the survey to include four new countries: the United States, the United Kingdom, Germany, and Australia.

The findings were remarkably similar across all six countries. Among the general population, there’s wide support for compulsory vaccination rules. And even more startling, the ranks of unvaccinated see some merit in selective vaccination mandates. For example, there is overwhelming support for requiring teachers and health care workers to get vaccinated across all those polled. Requiring that private sector workers be vaccinated draws less support, but there’s still a majority in all but the U.K.

Even in the United States, where mandate battles have raged from state to state since the early days of the vaccination campaign, a majority of poll respondents are seemingly okay with rules requiring vaccination to enter workplaces, shops, and attend public events. This finding comes as courts across the country, and even the U.S. Supreme Court, strike down a variety of enforcement orders that would have required employees at large businesses get vaccinated, undergo weekly testing, or simply wear a mask.

But what continues to surprise pollsters the most is that the most strident blocs in each country—the unvaccinated—are showing signs that they, too, will go along with tougher measures in certain circumstances.

Call it a case of Omicron fatigue: This highly infectious variant is testing the resolve of even the most dogged anti-vaxxers, the pollsters find.

“They are definitely not a group of people that are hard-core sure they are right,” says Andrei Postoaca, CEO of Ipsos Digital. The data from these surveys tell him that there is probably one-quarter of the remaining unvaccinated who don’t fall into the strident “true believer” category. “More and more are willing to take a jab, are willing to accept a mandatory vaccination. So the question is: Step by step, will you get people to cross the line” and drop their opposition to vaccines and vaccine mandates?

“What I would say is clearly the vaccinated support a decision of mandatory vaccination. And a decent chunk of the unvaccinated in most countries also support it,” Postoaca adds.

The poll suggests that about 13% of unvaccinated Americans are planning to get their first COVID shot. That’s not a lot, but if it’s accurate it would raise the overall vaccination rate in the US by about four points, and that’s not nothing. Here’s hoping.

“Maternity deserts”

I have three things to say about this.

A few weeks ago, a woman gave birth at Hereford Regional Medical Center, a critical access hospital in the Texas Panhandle.

Or, rather, the woman gave birth in the parking lot at Hereford Regional Medical Center after driving over an hour to get there, according to Jeff Barnhart, the hospital’s chief executive.

Barnhart said he’s heard it all over the years: patients giving birth at rest stops and in ambulances and in the car on the side of the road. The hospital’s patients come from a 1,600-square-mile area in the Texas Panhandle, and some of them just don’t make it in time.

But now, even patients who do make it to the hospital have another variable to contend with: critical staffing shortages and exploding COVID-19 case counts. There are days when Hereford Regional doesn’t have enough nurses to operate the labor and delivery unit, forcing it to divert patients 50 miles northeast, to Amarillo.

“We give them a medical exam and see if there’s time to get them in an ambulance to another hospital that can take them,” he said. “But sometimes, that baby’s coming and there’s just not time.”

Those patients give birth in the emergency room, an increasingly common occurrence as rural hospitals limit or cease labor and delivery services due to insufficient staffing.

Nationally, the health care system is facing an unprecedented labor shortage as nurses retire, resign, burn out or leave staff positions for more lucrative travel nursing contracts. Rural hospitals, many of which already operate with a shoestring staff, are especially hard hit.

Declining populations and cuts to Medicaid and Medicare funding have made Texas the national leader in rural hospital closings, with some 26 closures — permanent or temporary — of rural facilities in the last decade. Two-thirds of the state’s 157 rural hospitals are public, which means less flexibility in salary negotiations. Administrators also say it’s often difficult to recruit medical personnel to smaller towns in remote counties.

Struggling to survive, the remaining hospitals in Texas’ rural communities have had to cut back services. And when that happens, labor and delivery is often the first to go.

Only 40% of Texas’ rural hospitals still have a labor and delivery unit, according to the Texas Organization of Rural and Community Hospitals, leaving whole swaths of the state without access to nearby obstetrics care.

“If we’ve got nurses to cover a day, of course, we’re going to try to take care of everything that we can here,” Barnhart said. “But it’s just a scheduling crisis, and whenever we can’t make it work, we just let the hospitals in Amarillo know so they can expect it.”

Before I get to my points I want to say this is a good story and you should read the rest. Now…

1. There have been a lot of stories in recent years about the serious problems that rural communities have in accessing emergency health care because so many rural hospitals have closed down. This is a corollary of that problem, and I have a lot of sympathy for everyone involved. But as is my wont, I can’t help but see these stories through a political lens. These areas are overwhelmingly Republican. Republican politicians like Greg Abbott have done everything in their power to continue that cycle, with the fanatical refusal to expand Medicaid at the top of the list. To be sure, there are problems beyond that, and the overall demographic trends are a big factor as well, but however you look at it their representatives and the state leaders that they keep voting for have done nothing to help them. Just once, in one of these stories, I’d like to see that question explored.

2. I should note that while Abbott and state leadership and Republicans in Congress and the Lege are the main actors in this drama, sometimes it’s these same rural communities that bring the damage on themselves. I say I have sympathy and I really do, but boy does it get tested sometimes.

3. I’m old enough to remember that one of the arguments made by the defense (i.e., the state of Texas) in the Whole Women’s Health v Hellerstedt case, in which a very different SCOTUS decided that the 2013 version of Texas’ radical anti-abortion law was unconstitutional, was that forcing women to travel up to 250 miles to get an abortion because all of the clinics closer to her had been closed down as a result of that law represented an “undue burden”. I wonder what those folks think about forcing women who are actively in labor to drive a hundred miles or more to give birth because your healthcare policies have resulted in the closure of hospitals and maternity wards closer to them. Haha, I’m kidding, I don’t wonder that at all. I know for a fact that they don’t care. But still. You, a normal person, might think that’s not such a great thing. Yet here we are.

You don’t want to go to the ICU right now

And even if for some reason you did want to go to the intensive care unit, there probably wouldn’t be room for you.

The number of Texas intensive care unit beds available for adult patients is at an all-time low for the pandemic, with only 259 staffed beds open across the state as of Wednesday, as hospitals fight a historic staffing crisis and more unvaccinated people infected by the omicron variant pour into hospitals.

That’s 11 fewer beds than the previous record set in September during the deadly surge of the delta variant of COVID-19, according to the Texas Department of State Health Services. An average of 295 available beds has been reported in the last week, which is also lower than previous record averages.

The crunch on the state’s intensive care units comes as patient cases skyrocket and as hospitals themselves work to fill shifts left open by more workers home sick from COVID-19.

As of Wednesday, more than 13,300 hospitalized Texans have tested positive for the virus.

“Because of the high level of transmission and infectivity of the omicron variant, so many of our staff are getting positive,” said Bryan Alsip, chief medical officer for University Health in San Antonio. “We’ve been doing this a long time now — close to two years. We’re now experiencing our fourth large surge of those patients. It can get tiring.”

Alsip said University Health — the public hospital system for the San Antonio and the third largest of its kind in the state — is approaching numbers of hospitalized COVID-19 patients that the system has not seen since the last deadly surges in the early months of 2021 or the fall and summer of 2020.

[…]

But while omicron is putting fewer patients into the ICU than in previous surges, there are also fewer ICU beds that are able to be staffed due to a nursing shortage, officials say — and the sheer number of omicron cases is pushing patient counts higher.

The bottom line, they say, is that there are fewer beds for any Texas patient who may be suffering a serious medical event and need intensive care — whether they were put there by omicron or not.

So yeah, now when people tell you to drive safely, it’s more than just a bit of politeness. We might be reaching peak omicron, but as noted before hospitalization is a lagging indicator. There’s still a few weeks to go before we start seeing declines in those numbers.

While it would be nice to think that once this omicron wave recedes we’ll be in for a longer period of calm, but Dr. Peter Hotez says don’t count on it.

Q: There’s a lot of talk about omicron creating herd immunity and the transition from pandemic to endemic. Your thoughts?

A: The big picture, I’m still concerned about. There’s a lot of happy talk about omicron somehow acting as a weakened virus, herd immunity and the end of the pandemic. I do not think so yet. I think we’re in for another wave this summer across Texas and it could be just like 2020 and 2021. Here are the reasons why.

One: I’m not convinced the durability of the protection from omicron is going to be adequate. It may resemble the short-lived immunity you get from the upper respiratory virus. The population could still be vulnerable in the spring.

And vaccination rates are still not great in lower- and middle-income countries where these variants arose. I think we’re still very vulnerable to another variant arising in Africa or Asia.

Q: As you pointed out, that runs contrary to a lot of the hopeful buzz about omicron that I’m coming across.

A: Yeah, you hear that coming from the White House. And I’m hearing it from a lot of my talking head colleagues. But to me, right now, that rings hollow. I don’t think it’s wise. I think what we need most urgently right now is a national strategy for how we’re going to prevent another big variant in the summer from hitting Texas and the southern United States. Here’s what I think that strategy requires.

One: a strategy for global immunization against COVID-19, which just doesn’t exist now. The White House announced another 400 million doses, which is slightly more than what our Texas Children’s vaccine has done. We need 9 billion doses.

Second: We need a greater understanding about the durability and protection from the mRNA boosters. We’re getting conflicting results about the durability. That needs to be clarified. We need to understand that for a strategy for moving forward. Whether we keep the singular focus on the mRNA vaccine or broaden our COVID stockpiles to include additional technology.

And let me say, third: What’s our plan for global surveillance? So far we’ve been surprised by every major variant of concern. We need predictable surveillance models, but we don’t have them. That’s a need. What I’d like to see coming out of the White House is a national strategic task force to really dive into those three components. We need a realistic plan for the country. And I just don’t get the sense we have that right now. Nationally, we’re still in reactive mode every time.

As noted, Dr. Hotez and his colleague Dr. Maria Elena Bottazzi have done what they can to help with global vaccine supply. But we still need to get more shots in arms here – ESPECIALLY KIDS – and I don’t know what we can do to make that happen. Rewards and gimmicks might help a little around the margins, but not enough to really make a difference. The various federal mandates would have made a real difference, but well, you know. Your safety is officially in your hands. Don’t screw around with it.

The Rodeo will (probably) happen

Assuming it all doesn’t go south from here.

Harris County Judge Lina Hidalgo said Tuesday the Houston Livestock Show & Rodeo should proceed as planned, citing a decline in COVID-19 cases and hospitalizations.

“It’s difficult to predict what things are going to look like in a month, but I’m very hopeful,” Hidalgo said. “I hesitate to say A-OK, because I know what our hospitals are facing.”

She did not rule out, however, shuttering the event for the third straight year if trends reverse.

Hidalgo returned the county to its highest virus threat level on Jan. 10, which urges the more than 1 million unvaccinated residents here to stay home and avoid unnecessary contact with others.

There is growing evidence that the omicron wave is waning in the Houston region. Virus hospitalizations have declined 8 percent since peaking on Jan. 18. Unlike previous surges, the Texas Medical Center has never exceeded its base ICU capacity while dealing with omicron.

Last year’s Rodeo was cancelled, and the 2020 Rodeo, which began just before COVID became a known threat here, ended early, though some argued at the time that decision took too long. Our current numbers are headed in the right direction and should be better in a couple more weeks. I doubt I’d be ready to attend actual Rodeo events or one of the concerts, as those are all indoors, but I expect that going to the fairgrounds for a day of outdoor activity ought to be fine. Especially, you know, if you’re vaxxed and boostered. Wearing a mask, at least when you’re in line and definitely when you’re getting food, would also be a good idea. Do what you think makes sense for your risk profile.

I repeat: We need to get more kids vaccinated

Come on, Houston.

In spite of the spread of the omicron variant, national COVID-19 vaccination rates for children ages 5-11 remain low. The same is true for children in Harris County, according to a Kaiser Health News analysis of CDC data.

Of Harris County’s children aged 5-11, only 18.2% of them are fully vaccinated; 22.2% have received one dose. Pharmaceutical company Pfizer announced the FDA authorization of their COVID-19 vaccine on October 29, 2021.

In Texas, most counties have low vaccination rates. Only 34 of Texas’ 254 counties have child vaccination rates above 10%.

When compared to other counties in the U.S. with child populations over 100,000 Harris County comes near the bottom of the list when ranked by vaccination rate.

At 13% fully vaccinated, Harris County’s child vaccination rate is barely higher than Dallas County’s (11%), lower than Bexar County’s (14%) and is about half of Travis County’s (26%).

That 18.2% cited appears to be a typo – according to both the embedded image in the story and the Kaiser Health News story, the actual figure is 12.8% for Harris. Half of what Travis County has done to this point, in other words. We have to do better than that.

And as a reminder why, there’s this.

Vaccines continued to provide strong protection against death from COVID-19 in December, even against the new omicron variant, according to state data released Friday.

Unvaccinated Texans were 16 times as likely to die from the virus in December, and were two times as likely to test positive for it. That gap has shrunk from the fall, likely due to omicron’s increased transmissibility.

The divide was most evident for Texans between 65 and 75 years old, who were 19 times more likely to die from COVID if they were unvaccinated. Nearly 80,000 COVID deaths have been reported in Texas since the pandemic began, the majority of them in 2021, when vaccines became available. Just under 1,600 deaths were reported to the state in December.

Yes, not being vaccinated is not the same risk for a 5-year-old as it is for a 75-year-old. But still, there are a lot more kids in the hospitals these days, and the little ones can certainly spread COVID to their elders. Get them their shots already.

Spare a thought for the nurses

And do everything you can to avoid getting COVID.

[Kristen McLaury, a nurse and unit manager at Methodist Hospital The Woodlands] treated one of the hospital’s first COVID patients and hasn’t stopped since. She now runs the respiratory unit, where she and her nurses have watched otherwise healthy young people gasping for breath. They’ve put countless people on oxygen, or taken them off life-support. They’ve had to comfort grieving families, and facilitate video calls so no one had to die alone.

She’s risked her own life on the frontlines for nearly two years, and now, watching these hospital beds fill up again, she just feels defeated. In Montgomery County, a conservative, wealthy suburban county northwest of Houston, only 53 percent of its more than 600,000 residents are vaccinated, which is among the lowest rates for Texas counties with populations exceeding 500,000. Less than 16 percent of residents have received a booster shot.

“I work 60 hours a week and I don’t see my child, I don’t see my husband, so that I can come and care for you while you yell at me because you’re upset that you have a disease that I told you how to prevent in the first place,” McLaury said.

As the unit manager, it’s McLaury’s job to keep morale up among the other nurses, a herculean task right now. Like every hospital across the country, they’re facing a nursing shortage, an increase in employee infections and a potentially terminal case of staff burnout.

As the omicron variant surges, Texas is on track to soon surpass its previous COVID hospitalization record, set in January 2021. Then, at least, there was the hope of vaccines on the horizon. Now, nurses like McLaury don’t see much hope at all.

From behind her Houston Astros mask and face shield, she begins to cry.

“It’s real, and maybe it might not be you [in the hospital], but it might be somebody else,” she said. “That compassion, I think, is just gone. The world has become so selfish.”

[…]

“Patients stay in the lobby for my entire shift,” said Meredith Moore, an emergency room nurse. “12 hours. It’s frustrating. It’s hard for them…and they get angry. It’s justified. But who receives that anger? Me.”

Moore has been a nurse for nine years and joined the emergency department here since soon after the hospital opened in 2017. She’s young and energetic, with expressive eyes that communicate exactly what she’s thinking — even behind a mask.

Before the pandemic, Moore loved the fast-paced environment and the feeling of helping people who really needed it. She was especially good at controlling her emotions, a requisite for this job.

“In the ER, you have a patient die on you and you have to go into your next room, and you have to act like nothing is wrong,” she said. “That has gotten more difficult as this has gone on.”

Last week, for the first time, she broke down and cried in the emergency room.

“I had five ambulances that had to have a bed…I had a patient that was circling the drain…I don’t have a nurse to take care of that patient,” she said. “That was the first time in two years I really felt helpless, because if one thing falls, if one person starts coding, it’s all over. It all goes up in flames.”

“I don’t think that people [know] unless you’re on this side,” she said. “I tell my family all the time. I’m glad you don’t know. But that’s a heavy burden to carry.”

The article started with a focus on one of the patients at Methodist Hospital The Woodlands, some unvaccinated dude who didn’t believe in the science of vaccines but was more than happy to trust the science of hospitals. I think we’ve heard enough from people like that. The rest is about the nurses and their experiences, and we need to be more aware of what they’re going through. Go read it.

Have we reached peak omicron?

I sure hope so (fingers crossed).

Omicron’s swift and sudden surge may have peaked, experts said Monday, but hospitals are likely to remain full in the coming weeks, with the highly contagious COVID-19 strain not expected to recede until March.

Two key metrics — transmission rate and wastewater tracking — indicate the variant may be loosening its grip on the Houston area.

Texas Medical Center records show positive case rates are declining. Around 9,000 people tested positive for COVID each day last week in the greater Houston area, down about 40 percent from the previous week, when the region averaged about 13,400 new cases daily, according to TMC data.

But hospitalizations and deaths lag behind new infections, so health care workers still have a challenging couple of weeks ahead, said Dr. David Persse, Houston’s chief medical officer. Intensive care units around Texas are at 92 percent capacity, among the highest levels recorded since the pandemic began.

“It appears that we may have hit a peak,” Persse said. “However, our numbers are still really really high. I hesitate for anyone hearing that we may have peaked to think that its over. It is far from over.”

[…]

Houston’s declining rate of transmission — a statistic used to gauge how likely an infected person is to spread their illness to others — offers some clues. The rate of transmission fell below 1.0 last week for the first time since mid-December, according to new TMC data. That means each infected Houstonian is spreading the virus to less than one other person.

The city’s wastewater offers another optimistic sign of omicron’s decline. The wastewater virus load last week was about half what it was in December, and appears to be falling precipitously from its all-time high recorded on Jan. 7, officials said.

As a reminder, the wastewater dashboard is here. It’s still high, but compare to January 3, and you’ll see how much better things look now. As noted, hospitalizations lag cases, and deaths lag hospitalizations, so while the number of people getting COVID may now be trending down, we’ll still see high levels of hospital bed usage, and a higher death rate for the time being. But at least there we can begin to see the end as well. Hang in there, and stay safe.

Have I mentioned that we need to get more kids vaccinated?

Seriously, y’all.

Since November, 693,345 Texas elementary-age children have received at least one dose of the vaccine, accounting for about 24% of the state’s 2.9 million children ages 5-11 — and a figure in line with the national rate. Nearly 390,000 of the 5-11 group are fully vaccinated, while more than half of Texans ages 12-15 are fully vaccinated.

Texas’ child vaccination rate is higher than in many other Southern states, where rates as low as 10% are being recorded. In the first two weeks after the shot was approved for emergency use in the younger age group, some 100,000 children showed up to Texas school clinics, pharmacies and pediatricians’ offices to get inoculated.

[…]

At Texas Children’s Hospital in Houston, positive cases among patients went from zero in early December to some 70 patients with COVID-19 a month later, mostly among unvaccinated children, said Dr. Jim Versalovic, pathologist-in-chief for the hospital. Their hospitalizations of children with COVID-19 broke all previous pandemic records, and at breakneck speed, he said. Just weeks after omicron was first detected in Texas, it was causing more than 90% of new cases showing up at his hospital — less than a month after the vaccine was approved for young kids.

“We have staggering numbers here during this omicron surge,” Versalovic said in a news conference in early January.

That same day, the state broke its own record of children hospitalized with COVID-19, reporting 350 — five more than the previous peak a few months before.

On Friday, the state health department released data on 3.8 million confirmed cases of COVID-19 in Texas in the first two years of the pandemic. Almost 19% of them — 722,393 — were diagnosed in residents under age 20. The demographics do not include cases reported in 2022.

During the first week of January, the Texas Department of State Health Services and the Texas Education Agency reported that about 26,500 students and 11,800 staff members had been infected with COVID, according to data released Friday.

While the numbers of student cases are nearing levels not seen since the start of school last fall, there are more cases of COVID-19 among staffers than at any other time in the pandemic. The numbers are likely to increase as more districts report their numbers to the state. The current numbers include only about half of all of the state’s 1,200 districts, and the number of districts reporting any numbers is inconsistent from week to week.

Meanwhile, on Wednesday, the state reported 471 children in Texas hospitals with COVID-19. Most of them are unvaccinated, hospital officials have said. But there is no state data detailing how many COVID-19 child patients are in Texas pediatric intensive care units.

Yes, I’ve said this before. The numbers have climbed a bit since then, but there’s so much farther to go. As was the case with previous iterations of the vaccine, there was a large initial burst of activity, as the folks who had been eagerly awaiting the day that it became available for that group rushed out to get it, then it leveled off. The difference is that this time that initial burst was much smaller. Gotta say, I have no idea why. Get your kids vaccinated. What are you waiting for?

Back to Code Red

Hopefully not for too long.

Harris County Judge Lina Hidalgo on Monday moved the county again to its highest COVID-19 threat level, her office said.

The announcement should be old hat for Hidalgo, who has moved to Level Red each of the past three calendar years.

“Unfortunately, today we find ourselves crossing a threshold we don’t want to cross,” Hidalgo said at Booker Elementary School in Spring ISD. “We are in the midst of another COVID-10 tsunami.”

She cited an explosion of new COVID-19 cases. She expounded on the dangers of the new Omicron variant. She pointed out that virus hospitalizations are increasing at a higher rate than ever.

Twenty-one months into the pandemic, a question looms: How many people are still listening?

Schools are back in session. Restaurants, bars, theatres and sports arenas are open to capacity. There are no county- or state-wide mask rules. Moving to Level Red does not change any of that; instead, it urges unvaccinated residents to stay home and avoid unnecessary contact with others. The decree is not enforceable.

[…]

Hidalgo has made warning the public about COVID-19 central to her messaging since the pandemic reached Texas in March 2020. For more than a year, she and county public health officials have cajoled, implored, exhorted, implored, advised, recommended, begged and even bribed residents to get vaccinated.

Hidalgo tried to remain optimistic, reasoning that getting more residents inoculated is the way to retreat from Level Red and never return.

“We can break that habit,” Hidalgo said. “I don’t want this always to be bad news.”

Growth of the county’s rate of vaccinated residents has slowed significantly. It now stands at 59.8 percent, up just 3.3 percent since before Thanksgiving. At this rate, 70 percent county of county residents would not be vaccinated until July.

See here for the previous time the threat level was raised. It’s a fair question whether anyone is still listening. I never really stopped wearing masks for indoor things like grocery shopping and ordering at restaurants – I eat outside if at all possible – but now I’m wearing KN95s instead of cloth masks. In my observation, we’re nowhere close to the levels of mask wearing we had a year ago, and few places are doing much about it. I guess we’re going to got for a low-rent version of herd immunity, at least for the short term. Better hope that the “milder” part of this strain holds up. More here from the Chron.

The hospitals are getting slammed again

Take precautions, y’all.

Pandemic forecasters in Texas say the state’s current surge of omicron infections and hospitalizations is likely to get much worse before it gets better, with hospitalizations expected to continue climbing for at least three weeks if social behaviors don’t change and slow the trend.

Across the nation, hospitalizations are already on the verge of breaking new pandemic records. In Texas on Thursday, according to state data, about 9,200 people were hospitalized with COVID-19 — far short of the record 14,218 hospitalizations from Jan. 11, 2021.

But with current numbers climbing exponentially each week, hospitalizations of Texans with COVID are likely to follow national trends and surpass previous levels in the state before they start to decline, said Anass Bouchnita, a researcher at the University of Texas COVID-19 Modeling Consortium, which uses data and research to project the path of the pandemic nationally.

The number of Texans testing positive for the virus every day is already at an all-time high, reaching a seven-day average of almost 44,000 confirmed cases on Friday. The seven-day average of new confirmed cases during the peak of the delta surge back in September was over 15,000.

That trend is likely to continue for at least another week, Bouchnita said.

“The situation in Texas is that it probably won’t reach the peak [for cases] until the second half of January,” he said.

Experts say the extremely high case count is why so many people are showing up in the hospital even as medical evidence suggests that the omicron variant — responsible for most new and active cases in Texas — is less severe than the previously dominant delta variant.

Bouchnita talked to The Texas Tribune on Friday, the same day the UT consortium released a report with the research team’s latest calculations about omicron’s projected path nationally. The report, which looked at eight scenarios in which omicron had varying degrees of severity, infectiousness and resistance to immunity, suggests the nation could see its new cases of this more contagious but less severe strain peak by mid-January before decreasing by half in early February.

The report called the current surge the largest COVID-19 wave in the United States to date.

[…]

Intensive care units at more than 50 hospitals are at 100% capacity, according to state reports, and some regions of the state, including El Paso, are reporting no ICU beds available in the area.

Already, the state’s children’s hospitals have more patients with COVID-19 in their beds than at any other time in the pandemic — 351 statewide on Thursday, which is higher than the last peak during the delta variant surge of 345 in early September.

“It’s pretty crazy,” said Frisco pediatrician Dr. Seth Kaplan, immediate past president of the Texas Pediatrics Society. “Our volume is way up.”

It’s mostly omicron now, very little delta in Texas, though there’s still a fair amount of delta in other parts of the US. It is true that omicron is less severe than delta, but it’s also true that it’s far more transmissible, and it’s affecting far more vaccinated people. Even with less severity, the sheer number of people being infected is driving the higher number of hospitalizations.

And while more vaccinated people are being infected by COVID, there’s still a big difference in outcomes between the vaxxed and the unvaxxed.

Omicron is sending a larger share of vaccinated people to the hospital that any previous COVID-19 variant, but unvaccinated people are still more likely to need critical care, according to Houston-area hospital officials.

Twenty-two of the 27 COVID patients in Harris Health System’s intensive care units are unvaccinated. At Houston Methodist, roughly 60 percent of the 80 COVID patients in the ICU are unvaccinated, and a high percentage of the remaining patients have underlying health conditions, said Dr. Faisal Masud, the hospital’s medical director of critical care.

It’s a similar story at St. Luke’s Health and Memorial Hermann Health System, both of which say 70 percent of ICU patients are unvaccinated.

“The vast majority of the people who are critically ill are either unvaccinated or have significant comorbidities,” said Dr. James McCarthy, chief physician executive at Memorial Hermann. “We are not seeing middle-aged, healthy, vaccinated individuals in the ICU like we did in the previous wave.”

[…]

Statewide, the number of patients in the ICU has been steadily rising since Christmas Eve, from 1,030 to 1,711 on Wednesday, according to the Texas Department of State Health Services. That’s about half of the patients in the ICU at the peak of the delta wave, but some Houston hospitals are already seeing ICU rates double over the last week.

The number of incoming ICU patients could exceed all previous peaks, said Dr. Esmaeil Porsa, president and CEO of Harris Health System. While the vaccines may not be as effective as they were initially, the current ICU population indicates that “they are still extremely effective against severe disease,” he said.

“More and more breakthrough infections are going to happen,” Porsa said. “We’re going to get a higher percentage of people who are vaccinated, but that number is never going to be a big number. It’s always going to be minority of people.”

Overall, doctors say omicron is not damaging the lungs as much as earlier strains. Fewer COVID patients in the Harris Health ICU require mechanical ventilation compared to delta, said Porsa, but other health issues like kidney and heart failure are becoming more common.

At Methodist, Masud has observed a similar pattern. A large portion of ICU patients Masud has treated ended up in the unit because the virus exacerbated an existing disease. The risk of facing such complications is higher for unvaccinated people, he said.

“This is eliciting an immune response, which is not only limited to lungs but which makes the patients sicker, with existing disease becoming much worse,” he said.

Masud said that now is a critical time to wear a well-fitted mask in public, especially for people who are not vaccinated.

It’s the same as before, in that the things you can do to mitigate your risk haven’t changed. Get vaxxed, and get your booster. Wear an N95 or KN95 mask when out with people. Avoid large indoor events and gatherings. Stay home if you’re not feeling well. This will pass, but how bad it gets before it passes is still up in the air. For more on the national picture, see TPM, Mother Jones, and Daily Kos.

Got to keep an eye on the hospitalizations

They’re up, but for now we’re still in reasonably decent shape.

More than 1,200 people were hospitalized for COVID-19 in the Houston area on Monday, according to data released by the state Tuesday afternoon. The Department of State Health Services reported that 1,224 people were hospitalized for COVID-19 in the nine-county region around Houston.

The figure comes one day after the state reported topping 1,000 hospitalizations for the first time since October as the delta wave tapered off.

The hospitalization rate represents a 93 percent increase over last Monday, when DSHS recorded 636 COVID hospitalizations in the Houston area. The surge corresponds with the rapid spread of the highly-transmissible omicron variant, which first appeared in South Africa in late November, and has swelled to account for more than 90 percent of local cases in recent weeks.

Houston’s hospitalizations are still well below their delta peak, which reached 3,500 on Aug. 24. But less than a week after Houston  logged its 300,000th case of COVID, data from the Texas Medical Center shows that local transmission is increasing at a steady rate.

The current transmission rate is high – basically, on average everyone who gets the omicron variant will pass it on to another two people – and our vaccination rates remain pathetically mediocre. Harris County is better than the state overall, but not by much. There’s still a lot of room for this thing to find vulnerable people. Use rapid tests, isolate if you get a positive result, and wear good quality masks. We really can get through this if we’re not too dumb about it.

Back to threat level orange

Thanks, omicron.

Harris County Judge Lina Hidalgo raised Harris County’s COVID-19 threat level to “significant” Monday, as the number of infections rise sharply, sparked by the spread of the omicron variant.

“Level 2: Orange,” is the second-highest threat level in the county. While it falls short of suggesting that residents stay home under all circumstances, Threat Level 2 recommends that people minimize all uneccessary contacts in order to stem the flow of the virus.

“Unfortunately, the Omicron variant has arrived in Harris County in full force,” Hidalgo said in a statement. “These trends are understandably frustrating — especially as we close out the year with friends and family. But we can still blunt the force of this latest wave if we take action.”

New cases in the area have nearly tripled in the last week, with the Texas Medical Center reporting about 2,094 cases per day compared to about 721 the week before.

The COVID-19 testing positivity rate has jumped from 2.7 percent to 6.2 percent in that span, and hospitalizations at the medical center have grown from about 68 people per day to about 110.

As noted, it was less than one month ago that the threat level had been lowered to yellow. Those were the days, huh? And now we’re back to this.

Jayne Johnston broke the bad news on Saturday to her 6-year-old daughter: Theater Under the Stars’ production of “The Little Mermaid” was canceled.

“She was crushed because she was so excited,” Johnston says. “I made this big deal about her getting vaccinated. I’d told her, ‘You’ll get to go inside places again, but you’ll still have to wear a mask.’”

The mother-daughter duo had planned to see the 2 p.m. performance at the Hobby Center. At the time, another show was also scheduled for 7:30 p.m., but it was canceled, too.

“While we had hoped to resume performances on Sunday, we have confirmed a positive COVID case among our performing company,” said TUTS artistic director Dan Knechtges in a statement. “Our paramount concerns are for the health and safety of our artists and audiences. It does, regrettably, put us in the position of making hard decisions and cancelling performances this weekend. Performances will resume on Tuesday, December 21.”

The spread of the omicron COVID variant and the recent spike in cases is beginning to affect live theater, sports and other public gatherings in Houston.

[…]

Similar to TUTS, Alley Theatre’s guest services team alerted patrons on Saturday a person working on ‘A Christmas Carol’ tested positive for coronavirus. Ticket-holders can requests seats to a future show date through Dec. 29, or any future Alley production. Refunds are available, too.

“It’s disappointing because we’ve done so well this whole run of ‘A Christmas Carol,’” says Dean R. Gladden, Alley Theatre Managing Director. “We’ve done a lot to prepare, but the biggest thing you can’t prepare for is when it happens to you — you just have to deal with it.”

Gladden explains that his actors are already kept separate in respective bubbles. When someone tests positive for COVID, everyone — including production — has to provide negative results. That didn’t happen in time for Sunday’s performance. “A Christmas Carol” is expected to return to the stage on Tuesday.

“Patrons have been so understanding to know that it’s nobody’s fault. This is a very active variant,” he says. “We’re seeing this across the country. Performing arts are taking a hit, sports are taking a hit.”.

On Sunday, Rice University postponed a men’s basketball home game against University of St. Thomas due to COVID-related issues within the Owl’s program according to a statement. The women’s basketball team canceled Sunday’s game at Texas A&M University due to COVID issues, as well.

“With contract tracing, we didn’t have enough players to play the games. Basketball is a smaller team,” says Chuck Pool, Sports Information Director at Rice. There’s a slim chance both games could be rescheduled if the dates work out. “I can’t really speculate. These would’ve been our last games before Christmas.”

Not just colleges, and of course not just live theater:

Yesterday, a little after noon, the Dandelion Cafe posted a notice to its Facebook page. It echoed the sign newly posted on the door of this Bellaire breakfast staple: “Due to a rise in COVID cases, including several among our staff, we feel it is in the best interest of our staff, customers and everyone’s families to close until everyone can work and be in a safe and healthy environment.”

This unwelcome news was the leading edge of what is likely to be a spate of restaurant and bar closures over the holidays and into January, as the highly transmissible Omicron variant of COVID begins traveling through Houston on top of our current Delta wave.

COVID “seems to be picking up in the industry again,” bartender and diner-about-town Chris Frankel posted on Dandelion Cafe’s Facebook page today. “I’ve recently noticed a number of responsible, vaccinated colleagues testing positive and being stuck in quarantine.” Omicron’s ability to break through vaccine defenses is complicating the situation.

It sucks, but this is where we are now.

Houston doctors worry omicron could sweep the city just as families gather for the holidays. Omicron accounted for 82 percent of new symptomatic Houston Methodist COVID cases as of earlier this week, hospital officials said, and is on track to overtake delta as the dominant strain.

“This virus is better able to evade better the immune response we have developed through vaccination and natural immunity,” said Dr. Pedro A. Piedra, a virologist at Baylor College of Medicine.

Piedra estimates omicron will replace delta in the months to come. He is not alone in predicting an omicron wave, even as its severity remains a question mark.

Three weeks ago, Houston’s rate of transmission for coronavirus — a key indicator health officials use to gauge community spread — was 0.67, according to the Texas Medical Center. That means each person with the virus was likely to spread it to 0.67 people – nonviral, essentially. That rate has more than doubled as of last week, with a 1.58 rate of transmission.

The number of COVID-19 tests coming back positive in Houston has quadrupled since last week. Hospitalizations among children have doubled in four days.

The reason for omicron’s rapid ascent is written in its spike proteins, found on the surface of the virus that causes COVID. The variant contains a high number of previously unseen mutations that account for its ability to infect people faster and more efficiently than any previous iteration of the virus.

While scientists hurry to understand its properties, one thing is certain: its astonishing rise was months faster than that of delta.

“We have seen a rather dramatic shift,” said Dr. James Versalovic, pathologist-in-chief at the Texas Children’s Hospital.

You know the drill by now. Get your booster shot. Avoid large indoor crowds. Wear your mask – N95s are cheap and readily available now. Ventilate well. Use rapid tests and for God’s sake isolate if you’re positive. Minimize your risk and do what you can to protect others. We’re very much in a better place to avoid severe consequences, but we still have to be cautious. Yes, it sucks. The alternative is worse. Stace and the Press have more.

Omicron may be coming, but delta is still here

It’s still a big problem, in case we haven’t forgotten.

Omicron’s arrival in the U.S. came as no surprise to federal health officials and will be met with similar anticipation in Texas, where experts believe it could show up in state and local sequencing efforts as soon as this week.

“It’s almost certainly here,” said Dr. Benjamin Neuman, a Texas A&M University professor and chief virologist at its Global Health Research Complex, which does sequencing for COVID-19 variants.

On Monday, federal health officials concerned about omicron urged eligible vaccinated adults to get their booster shots to increase their protection from COVID-19, in whatever form it might take over the winter, and to keep masking, hand-washing and social distancing when possible.

In Texas, state health officials say they are ready to assist hospitals should another surge happen over the holidays and they are ramping up their own efforts to identify more variants in more parts of the state.

But their largest push, at least publicly, is for vaccination and booster shots. About 55% of Texans were fully vaccinated as of Dec. 1. Some 18.7% of fully vaccinated Texans have had boosters, according to state health numbers.

“Prevention is important, and vaccination remains our best prevention tool,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services.

[…]

Texas hospitals are still in the throes of a staffing shortage after almost two years of deadly surges and a summer wave of deaths and hospitalizations that saw record numbers of ICUs filled to capacity.

With more than 13 million Texans still not fully vaccinated, the fear of the medical community here is that another wave will further strain a health care system that is already exhausted and depleted.

At the moment, without more data about omicron, delta is still the variant likely to cause the most problems this winter, Neuman said.

“Today, it’s the delta wave that worries me. Not omicron yet,” Neuman said. “We’ve got to wait and see what omicron does, if anything. But with cases rising across the country — that’s entirely being driven by delta.”

There’s some interesting stuff in the article about how scientists in Texas are tracking different variants here – did you know there was such a thing as the Texas Variant Partnership? I didn’t – so read on. Everything I’ve read about omicron so far suggests it will be a couple of weeks before we have some real data on it, which will help us understand basic questions about how transmissible it is, how deadly it is, and so on. A huge question, especially in a still largely unvaccinated state like Texas is how much protection is natural immunity versus vaccination. I’m betting on the latter, but it’s certainly a possibility that another booster may need to be developed. Which, thanks to the nature of mRNA vaccines, can be done quickly, like three to four months. In the meantime, stay cautious and for crying out loud get your shots.

Harris County at “moderate” threat level again

For now. As with all things, for now.

The COVID-19 threat level in Harris County was reduced Friday to moderate from significant as the local number of hospitalized patients and new cases met thresholds that guide the meter while a new variant raised concerns that prompted countries across the world to once again restrict travel.

County Judge Lina Hidalgo’s office announced the change in the threat level after new data indicators turned yellow, the color designated to the level that calls for unvaccinated residents to remain vigilant, wear masks and continue practicing physical distancing, although can resume leaving home. Under the level, fully vaccinated individuals can resume activities without masking except where required.

The 14-day average positivity rate in the county reached 4.6 percent. As of Friday, 66.5 percent of the county’s population had received at least one dose of a vaccine and 57.2 percent were fully vaccinated.

The risks of the new variant, named Omicron by a World Health Organization panel, were not yet fully understood, according to the Associated Press.

The same panel that named the variant also classified it as a highly transmissible virus of concern. Numerous countries, including the United States, Canada and Russia, announced travel restrictions for visitors from southern Africa, where the variant was discovered, according to the AP.

In a tweet Friday evening, Hidalgo said she lowered the level “due to improved indicators” but cautioned “winter COVID spike is still possible.”

“Judge Hidalgo remains concerned about Omicron and the potential for a winter surge as we’re seeing in some other areas in the US,” spokesperson Rafael Lemaitre said Friday. “She is strongly encouraging residents who haven’t been vaccinated to do so — vaccines and boosters are widely available for free.”

I see from my archives that the threat level had been reduced to “Moderate” in late May, back when we all thought it was going to be a hot vaxx summer. Hopefully this time that will last a bit longer, but as before that will depend on getting enough people vaccinated. We’re making progress, and I remain hopeful that the vax’s availability for 5-11 year olds will help, but we still have a long way to go.

As for that new variant:

As global governments, scientists and health experts track the new omicron variant of COVID-19, Dr. Peter Hotez is encouraging people not to “push the panic button,” before we know more about it.

Hotez, who serves as co-director of the Center for Vaccine Development at Texas Children’s Hospital, said transmissibility is king in determining if omicron will impact the globe the way previous variants alpha and delta did. More data is necessary, he said.

“Before we press the panic button I think there’s a few things to consider,” Hotez said during an appearance on MSNBC. “Yes, it does have some immune escape properties, or at least it looks like it might, but that’s that’s not what’s associated with high transmissibility. We’ve had other immune-escape variants before that have not really taken off… That’s what I’m looking out for, the level of transmissibility.”

The good news, as I understand it from scanning Twitter, is that it was detected early on, and that PCR tests work to find it, which means that testing for it will be quicker and more effective. The vax makers say they can make a new batch for this in short order, it will mostly be a matter of getting it approved. So yeah, don’t panic yet, wait to see what the data says, and if necessary get yourself another booster. We’re much better placed for this now, if we’re not stupid about it.

COVID hospitalizations are (generally) down in (most of) Texas

For now. I think you always have to add “for now” to this sort of thing.

As Texans head into the holiday season, there is much to celebrate when it comes to addressing the pandemic. But health experts say the state is not out of the woods just yet.

First, the good news. The number of residents here hospitalized with COVID-19 is at one of its lowest points since the beginning of the pandemic, while average daily deaths from the virus are also dropping and vaccines are finally — after a year of parents anxiously waiting for approval — flowing into the arms of the state’s elementary age children.

After a miserable summer when the delta variant caused a surge that rivaled the worst moments of the coronavirus pandemic, state health officials and experts say they are grateful for signs of relief. But they’re wary of being too optimistic about a pandemic that has, more than once, had this state in a stranglehold.

“People are just kind of happy or relieved that the most recent surge is done with, but I don’t think anybody’s celebrating anything yet,” said Dr. James Castillo, public health authority in Cameron County. In that county, the share of hospital beds occupied by COVID-19 patients has dropped to 3% percent, down from over 25% during the summer surge.

Still, health officials are now watching a recent increase in the number of new confirmed COVID-19 cases and a small uptick in the rate of COVID-19 tests coming back positive as potential warning signs.

They’re also keeping an eye on a troubling new surge in the nation’s Western states that has hit El Paso, a region that was spared the deadly delta surge that rocked the rest of the state in August and September.

“We’re certainly in a better place right now than we have been in quite a while,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services. “But we are sort of starting to see things change again. And you know, if there’s one thing we know about this pandemic, it’s that it’s going to keep changing.”

[…]

Every day of good news, it seems, carries with it a note of caution.

At highest risk, officials say, are the millions of Texans who have not been vaccinated. During the month of September, at the height of the surge when about half of Texans had been fully vaccinated, unvaccinated people were 20 times more likely to die from the virus than those who had been vaccinated.

What that means, scientists say, is that a surge among the unvaccinated could still happen.

“Overall, our projections right now are fairly optimistic for the state of Texas,” said Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium. “But when we look at the winter, we’re still fairly concerned about what might happen in the future. … Our models suggest that there’s still enough susceptibility in our population to see another pandemic surge if we remove all precautions. I think Thanksgiving will be a lead indicator of what’s to come.”

As one of the graphics in this story shows, only 54.3% of the state’s population is fully vaccinated. So yeah, there’s a huge reservoir of vulnerable targets for the virus. And all of this is before we consider the possibility of new variants reaching our shores. If you’re fully vaxxed, you’re as safe as you’re going to be, but the old standbys of wearing masks and avoiding crowded indoor spaces are still in vogue. Don’t let your guard down.

More proof that vaccine mandates work

In the end, most people just get the damn shots. The rest is sound and fury.

Protests, lawsuits and national media coverage surrounded Houston Methodist Hospital in June when it became the country’s first major health system to require a COVID-19 vaccine as a condition of employment.

Now, as other Houston healthcare providers begin to enforce similar mandates, the drama has faded into the background. Hospitals are not facing the same pushback, officials say, and only a small portion of employees are holding out on the vaccine.

“There is a lot of noise around (mandates), and the anti-vaxx movement has been vociferous, but this is more of an outcry from the community rather than when it comes down to the brass tacks in facilities,” said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association.

Texas Children’s Hospital and Baylor College of Medicine were the first to reach their vaccine mandate deadlines following Methodist.

Baylor required its roughly 9,000 faculty and staff members to be fully vaccinated by Sept. 15. Those who did not attest to receiving their vaccine were subject to “progressive discipline,” which includes a series of warnings that ends in firing, according to a statement. The vast majority of employees complied, while about 3 percent were granted an exemption, according to numbers provided by the school.

One employee resigned. Another five will be fired after facing warnings.

[…]

Texas Children’s Hospital also passed its first-dose deadline on Sept. 21. Its doctors are employed by Baylor and already covered by the school’s mandate. In a statement, the hospital said “a very small number of employees did not receive the vaccine and therefore chose to leave the organization.”

Texas Children’s spokesperson Natasha Barrett said the hospital could not disclose a specific number of people who left or whether any exemptions were granted.

See here, here, and here for some background. A lawsuit by the (very small number of) fired Methodist employees was dismissed, though it is being appealed. There’s growing evidence from around the country that this is what happens pretty much everywhere that there’s a vaccine mandate – lots of loud whining and complaining and threats to quit, followed by near-universal compliance. This is why I’m happy for the San Antonio ISD vaccine mandate fight to move slowly through the courts, because regardless of outcome it’s going to cause people to get the damn vaccine. And don’t anyone tell Greg Abbott, but Southwest Airlines is doing a mandate now, too. The more, the very much better.

Don’t forget your flu shot

The flu is going to be back this year. Don’t fall for it.

After a historically light flu season in 2020, experts warn an influenza resurgence is looming this fall and winter.

“I would expect a more intense influenza season, simply because we did not have a flu season last year,” said Dr. Pedro Piedra, a virologist at Baylor College of Medicine.

Flu exposure breeds a level of natural immunity, creating a cellular memory of prior infections in those it infects. The absence of influenza last year, due to widespread masking and social distancing, has left many with a weakened immune defense — a development that could spell trouble as Texans venture out in droves this fall.

The return of the familiar body aching, fever-inducing wintertime scourge could not arrive at a worse time. Hospitals are still reeling from the fourth surge of COVID-19 spurred by the highly contagious delta variant and stagnating vaccination rates.

Experts predict flu season could hit Houston by early November.

“Now is the time to start making flu vaccine appointments,” Piedra said.

This past year was a historic anomaly due to COVID restrictions and precautions, and the lack of those plus a year out from anyone getting the flu we’re likely to see a resurgence. The flu shot may not be quite as effective this year, as it will be harder to model what it needs to be, but it will still be way better than nothing. Don’t miss out.

COVID rate slows a bit, but ICUs still full

The good news.

So far, the delta variant has fueled a month of Houston-area COVID hospitalizations over 3,000, according to the Texas Department of State Health Services.

But Texas Medical Center records show positive case rates may be slowly declining. According to TMC’s daily report, 1,939 people tested positive Tuesday in the Greater Houston area, a decline that may be related to COVID testing site closures as a precaution before Hurricane Nicholas.

Also Tuesday, the medical center admitted 310 new COVID-19 patients compared to the average 328 per day last week. Hospitals in the TMC remain at 90 percent capacity.

Dr. Wesley Long, a microbiologist and medical director of diagnostic microbiology at Houston Methodist, has been tracking and analyzing the virus and its variants through the hospital’s COVID-19 genome sequencing operation.

While Long sees the increase slowing, he hesitates to say Houston is passed the peak of the surge.

“It’s like cresting the top of the wave, you don’t know what the backside of the wave is going to look like,” Long said. “In the beginning of this fourth wave, there were some people hopeful it would go up quickly and come down quickly. That’s not the case.”

The fourth wave’s peak has been broader than previous waves, which spiked and declined within about 25-30 days, Long explained. The big question with the delta wave is whether it will plateau at a high rate of hospitalizations or have a slow decline.

“It’s hard to know how other things like holidays and school will affect the case count,” he said. “It’s really important to keep masking, social distancing and staying home if you’re sick because it’s important to bring the fourth wave under control.”

Another way to look at it:

The not so good news.

COVID-19 hospitalizations have been declining across Texas and the Houston region, but the virus is still keeping a high number of people in ICUs, prolonging the strain on patients waiting for critical care beds.

Last week, the number of available adult ICU beds in Texas sunk below 300 for the first time in the pandemic, with 270 beds available on Sept. 8 and 279 available on Sept. 9, according to the Texas Department of State Health Services. There were 326 beds available this Wednesday, including 65 in the nine-county region surrounding Houston, the data show.

Texas Medical Center ICUs for weeks have been hovering around 90 percent full with “Phase 2” surge plans — which add 373 ICU beds to the 1,330 available in Phase 1 — activated.

[…]

ICU data is a lagging indicator of the virus’s impact, [Dr. Syed Raza, vice president of medical operations at CHI St. Luke’s Health-The Woodlands Hospital] said, because the sickest patients need care for a longer period of time. He said it is the “natural course of the pandemic” for ICUs to remain high after hospitalizations decline.

Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine, said the hospital strain appears to be easing overall. The number of COVID patients in ICU beds likely peaked at the end of August, when they took up 49 percent of all critical care beds, he said. As of Wednesday, that number dropped to 45 percent.

He said he is cautiously optimistic that “we’ll continue to see this trend move in right direction.” He compared the current ICU situation to flooding during hurricane.

“We are no longer stuffing towels under the door” to stop the water, he said. “But the water is still over our threshold.”

I mean, it could be worse. It’s still not good, and it’s going to continue to not be good for awhile, but it could be worse. Keep up with the precautions, they’re our best hope in the short term as more people get vaccinated.

Hospital systems have no excuse for not mandating COVID vaccines now

So get on with it already.

Local hospitals reacted Friday to President Joseph Biden’s sweeping vaccine mandates directed at the health care workers, who make up much of the Houston workforce.

In a move that overrides Gov. Greg Abbott’s executive order barring public institutions from issuing their own COVID-19 restrictions, the administration said it would require vaccinations for employees at health care facilities that accept Medicare and Medicaid reimbursement.

Baylor College of Medicine’s dean of clinical affairs, Dr. James McDeavitt, said Thursday he supported the new measures.

“It is the right thing to do,” he said.

Still, he wished the plan had come sooner. “It is not going to help us with the current delta surge,” he added.

[…]

Five Houston hospital systems already require a vaccine. In June, Houston Methodist became the first hospital in the nation to announce it would require its staff to be fully vaccinated, a move that met months of resistance, including a lawsuit by some employees. Memorial Hermann and Baylor College of Medicine enacted their own vaccine mandates in July; St. Luke’s Health and Texas Children’s Hospital announced similar plans in August.

Thursday’s executive order will bring similar mandates to the city’s remaining health systems.

Until now, Harris Health System and UTHealth had encouraged worker vaccinations but were unable to require it under the governor’s order.

But on Friday, Harris Health System said it “fully intends to embrace the vaccine mandate” for workers at its two hospitals, 18 community health centers and 10 clinics serving the greater Houston area. The system has not yet set a date.

UT Health said it would wait for guidance from the Centers for Medicare & Medicaid Service, expected in October. It had not instituted a mandate as of Friday afternoon.

St. Joseph Medical Center and UTMB Galveston said they are still evaluating Biden’s plan.

While Kelsey-Seybold Clinic said in August it was waiting for full vaccine approval from the U.S. Food and Drug Administration before asking employees to provide proof of immunization, the clinic has not announced a mandate since the Pfizer-BioNTech vaccine gained full U.S. Food and Drug Administration approval late last month.

See here for the background. I agree that the mandate coming out now will have little to no effect on the current surge, given that it takes a few weeks to get both shots and the full effect of them, and that it will take time for these hospital systems to get their programs going. It would still be nice if some of them had more of a sense of urgency about it. This is still by far the best thing we can do for the medium to longer term, and at the very least these hospital systems should be setting a better example. Get it done already, y’all. The Trib has more.

A bit of good news in the wastewater

I’ll take it where I can get it.

Community spread of coronavirus is on the decline from its recent summertime high, but experts warn that Labor Day gatherings and kids’ return to classrooms could bring a rash of new infections in the coming weeks.

The latest samples of Houston’s wastewater — a highly sensitive method for tracking coronavirus — show diminishing traces of the virus across the region, said Loren Hopkins, the Houston Health Department’s chief environmental science officer. The results indicate a slight drop in person-to-person spread.

“The positivity rates are still alarmingly high, the wastewater rates are still alarmingly high, but it may be trending down,” Hopkins said Wednesday.

The decline could be short-lived.

The holiday weekend and the start of school, which spurred record infections among children, will likely keep the Houston area in “plateau mode” for the foreseeable future, said Bill McKeon, CEO of the Texas Medical Center.

On Tuesday, the Texas Medical Center reported that the rate of transmission across the Houston area was 0.87; the average for the previous week was 0.99. Both figures landing below 1.0 is a good sign; any number above 1.0 means the virus is spreading through the community.

Still, McKeon urged caution. Tuesday’s low daily transmission rate of 0.87 could be artificially deflated due to low testing rates, he said, which commonly occur over holiday weekends.

“We are just coming out of the Labor Day weekend and we typically do not see the impact of holidays for one to two weeks,” McKeon said.

[…]

Houston’s coronavirus hospitalizations slowed by 2.3 percent in the past week, but remained only slightly lower than August’s record peak. As of Tuesday, 3,370 people were in area hospitals for COVID-19, down from the record high of 3,500 on Aug. 24, according to the Texas Department of State Health Services.

Ballooning school transmissions are another concern, experts said, especially in districts that do not have mask mandates. Student infections are rapidly rising across the state, with the total number of positive cases among public school students surging by 90 percent just a few weeks into the new school year.

“We need mask mandates to protect our school children from getting infected and bringing it home to Mom and Dad,” said Catherine Troisi, an epidemiologist at Texas Medical Center’s School of Public Health.

The wastewater had documented to surge, and it will be the leading indicator when there is a real decline. I hope people were cautious over the Labor Day weekend, but we’ll know soon enough what if any effect that had. As for mask mandates in the schools, it seems to be working pretty well for HISD. I keep saying, none of this is a mystery, we know what we need to do, we just have to do it.

The contract health worker surge

Don’t know how sustainable this is.

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

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

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

[…]

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readin’ and writin’ and gettin’ COVID

Welcome back to school, kids.

Positive COVID-19 cases among Texas public school students rose by more than 9,000 last week, the highest number ever recorded in a seven-day period, state data shows.

As of Aug. 22, there were 14,033 reports of positive COVID cases in students across the state, according to data released by Texas Health and Human Services on Friday. The number represents a 182 percent increase from the 4,976 student cases reported through Aug. 15.

There were another 3,425 positive cases reported in school staff across the state, an increase of 712 from the previous week.

In some districts, more than half the new infections are among elementary school students, who are not eligible for any of the available vaccines.

“This school year is gonna look a whole lot different than last year,” said Dr. Katelyn Jetelina, an assistant professor of epidemiology at UTHealth School of Public Health in Dallas. “We have a whole lot more transmission now in the community and we have the delta variant.”

The cumulative number of cases in students since the 2021-2022 school year began is 20,256. The total staff cases so far this school year is 7,488.

In case you were wondering why so many parents are pissed about the fight against mask mandates. Now that all schools are open I would hope we won’t see any more big jumps like that, but we are going to see the case levels rise for now. I hope that at some point, when there’s enough data to be reasonably confident in the results, we can get a comparison of COVID rates in districts that have mandated masks versus those that have not.

On a related note:

People under 50 are being admitted to hospitals with COVID-19 in larger numbers than at any point during the pandemic as the latest surge of the coronavirus continues to tighten its grip on Texas.

According to data released by the Texas Department of State Health Services, as of Aug. 22, adults 30 to 49 now account for roughly 29% of all COVID-19 hospital admissions in Texas, up from 15% on Jan. 11 during the height of the winter surge.

The data shows that people in the 18-29 age group increased their share of admissions during that period from 5% to 7%, while the percentage of children under 18 admitted to hospitals with COVID-19 increased by 1 percentage point — an average of 46 children each day were hospitalized during the week ending Aug 22.

Meanwhile, fewer people over 70 are landing in hospitals with COVID-19. During the winter peak, about 41% of hospitalized COVID patients were over 70. As of Aug. 22, that dropped by almost half, to 23%.

The data confirmed what many doctors have been saying in recent weeks about the delta variant sending younger people into hospitals at a higher rate than earlier in the pandemic.

“We are seeing certainly younger patients hospitalized and younger patients on ventilators where we haven’t seen that before,” said Dr. Ron Cook, chief health officer at the Texas Tech University Health Sciences Center.

This variant has spread faster among unvaccinated Texans of all ages. As of last week, between 93% and 98% of hospitalizations have been unvaccinated people, depending on the area of Texas, officials said.

More than 70% of Texans over the age of 50 are fully vaccinated, compared to only about half of Texans between the ages of 16 and 49 and one-third of those ages 12-15. Children under age 12 are not eligible for vaccination.

And as the hospitals fill up with COVID patients, people who have other serious but treatable conditions are put in jeopardy. No amount of horse de-wormer is gonna fix that.

Other things the Lege has been up to

A brief roundup, to clear some tabs…

Bad Bail Bill 2.0 moves forward.

A sweeping revision of the process for releasing accused criminals on bail won initial approval from the Texas House on Friday night, nearly three months after the GOP-priority legislation stalled in the regular legislative session.

Senate Bill 6, which would require people accused of violent crimes to put up cash to get out of jail, tentatively passed the House on an 82-37 party line vote. The Senate passed the legislation earlier this month on a 27-2 vote.

A House committee advanced the bill Monday after taking out a controversial provision that would have restricted charitable groups from posting bail for defendants, a practice that gained popularity last summer when groups posted bail to release people arrested while protesting the death of George Floyd, a Black man murdered by a white Minneapolis police officer.

On Friday, House members added a related provision back into the bill that does not limit the ability of such groups to post bail. Instead, the amendment would require charitable bail funds to be certified by county officials as nonprofit organizations and file reports on who they bond out of jail.

“The original bill that came over [from the Senate] was essentially going to outlaw … the charitable bail process,” said state Rep. Travis Clardy, R-Nacogdoches, on his amendment. “We made it very clear to the other side of the building that this would not stand.”

The bill still needs to pass the House a final time before it is sent back to the Senate, which can either accept the House changes or enter into closed-door negotiations. State Sen. Joan Huffman, the Houston Republican who authored the bill, did not respond to questions about House changes this week.

See here and here for some background. This is bad, and there’s a decent chance parts if not all of it will eventually be found unconstitutional, but in the short term it will do some damage. Go read Grits for Breakfast or follow him on Twitter for a deeper dive.

Some virtual learning gets funded.

After months in limbo, Texas lawmakers took a step toward expanding and funding virtual learning as the pandemic still proves a threat to families not yet comfortable sending their children back to classrooms.

The Texas House approved Senate Bill 15 on Friday night in a 115-3 vote. The bill will go to a final reading and vote in the House before making its way to Gov. Greg Abbott’s desk.

The House’s initial approval of the bill will give some parents a measure of relief that there could be more virtual learning options as the pandemic once again strains the state’s resources. Hospitalizations and cases are surging due to the more transmissible delta variant of the coronavirus.

Necessary, albeit regrettable. We wouldn’t be revisiting this topic if we had a better handle on COVID, but given that we are not we need to acknowledge reality where we can. This is one reasonable place to do so.

More border boondoggling.

The Texas House approved nearly $2 billion in additional funding for border security operations, giving Gov. Greg Abbott more state dollars to implement his plans to build a border wall and incarcerate migrants for state criminal offenses in an effort to deter migrants from coming to the state.

Lawmakers gave initial approval Friday to a funding bill by a vote of 81-38 that would triple what the state allocated for border security during the last biennium. The $1.88 billion appropriated by House Bill 9 is in addition to the $1.05 billion lawmakers approved for border security this spring.

“There’s a crisis on our southern border with serious consequences extending throughout our state,” said Rep. Greg Bonnen, R-Friendswood, who authored the bill. “Texas must respond to the crisis that has been brought to our doorstep.”

In June, Abbott announced Texas would build a state-funded border wall to decrease the number of migrants entering through its border with Mexico. Earlier this year, the two-term Republican governor launched Operation Lone Star, an effort that directed state military and police resources to the border to aid local and federal authorities fighting the smuggling of people and drugs across the border.

Abbott, who is seeking reelection next year, had previously said he expects the state to build hundreds of miles of wall along the state’s 1,254-mile border with Mexico, but had not specified where the wall would be or how much it would cost.

This message has been paid for by the Greg Abbott campaign.

More money for “temporary” hospital workers.

Gov. Greg Abbott announced Thursday that for the second time amid a recent surge in COVID-19 hospitalizations that Texas will increase the number of state-funded relief workers it will be sending to Texas hospitals, bringing the total to 8,100.

The Texas Department of State Health Services had previously authorized contracting 5,600 medical personnel, and Thursday’s announcement adds 2,500 more.

During the state’s winter COVID-19 surge, more than 13,500 temporary medical workers were deployed across the state, according to DSHS. Those numbers began to dwindle once cases started to decrease and vaccinations became more widely available.

Now, the highly-contagious delta variant has pushed the state to reverse course and again take the lead in alleviating staffing shortages as hospitals are inundated with COVID-19 patients and intensive care unit beds are becoming scarce. On Aug. 9, Abbott directed DSHS to use staffing agencies to secure out-of-state medical personnel for Texas hospitals and asked hospitals to voluntarily halt elective medical procedures.

The state will fully fund the temporary health workers through Sept. 30.

Not technically a Lege thing, but Lege-adjacent. See my previous point about things we wouldn’t need to be doing if we had handled COVID better. I have no idea where we will find all these relief workers, but that’s yet another mess Greg Abbott will have to clean up for himself.

And finally, one thing the Lege hasn’t been doing:

And yet here we are. Still not too late, I suppose, but with every passing day this becomes more and more true.

Yes, the wastewater is also pointing to a COVID surge

In case you were wondering.

There is more COVID-19 in the city’s wastewater system now than at any time in the pandemic, city officials said Wednesday, the latest warning that the virus is spreading at an unprecedented rate.

Dr. David Persse, the city’s health authority, said there is more than three times as much virus in the system as there was last July. The volume also is higher than in January, during the most recent spike. Persse said that wastewater data, a precursor to other data points, show the surge will only grow worse in the coming weeks.

“We are at a level of virus in the wastewater that we have never seen before,” Persse said. “The wastewater predicts what we’ll see in the positivity (rate) by two weeks, which predicts what we’ll see in hospitalizations by about two weeks.”

[…]

The findings came during a news conference in which the city announced it will partner with Harris County and up to 17 school districts to vaccinate students over 12 and their families every Saturday in August, an effort they are calling “Super Saturday.” The inoculations will occur in school buildings throughout the region.

Persse described the state of the surge in stark terms, pointing to dire situations in area hospitals and rising cases and hospitalizations. The Lyndon B. Johnson Hospital declared an “internal disaster” Sunday night amid a nursing shortage and an influx of patients, circumstances officials said are occurring in other area hospitals, as well.

Texas Medical Center CEO Bill McKeon earlier this week said the region is “headed for dark times,” and the hospital system has exceeded its base intensive care capacity, opening unused wards to care for new patients.

“If you are currently unvaccinated, you need to consider that you represent a potential danger to yourself, and others, and most particularly your own family,” Persse said. “If you are not vaccinated… your chances getting through this without having to become either vaccinated or infected, is essentially zero.”

Just over 64 percent of Houstonians over 12 have received their first dose of the vaccine, according to city data, and 54.3 percent are fully vaccinated. The numbers among youth residents are more paltry, though: 28.1 percent of 12-17-year-old Houston residents are fully vaccinated, and 38.5 percent have received their first dose.

“If your child is 12 or older, stop and get them the shot,” said Houston ISD Superintendent Millard House II. “Increasing vaccination rates among our communities will help ease the worries of our families and their children returning to school.”

This is another one from earlier in the month, as things were really starting to get bad. We are familiar with this project, and it has been a big success. I just wish it had better news for us, but this is where we are. Getting more of those 12-and-older kids vaccinated would make a big difference as well, so I hope that effort is successful. We’re on our own, so we’d better act accordingly.