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Houston Department of Health and Human Services

Can we make it past July?

That’s when it looks like we’ll hit the peak of the pandemic here. And it could be ugly.

A surge in COVID-19 cases since Memorial Day could set the Houston area on track for a peak of 2,000 daily hospitalizations by mid-July, according to a model from a Baylor College of Medicine epidemiologist.

The region’s intensive care units would be overwhelmed by that number of patients, a nearly 50 percent increase from current levels, though thousands of general hospital beds remain available, said Dr. Chris Amos.

City of Houston Health Authority David Persse said several area hospitals already are at or over capacity, and warned that shifting patients to facilities in other cities, a common practice in natural disasters, may no longer be possible.

“The difference this time is the hurricane, if you will, is infecting the entire state,” Persse said.

With government restrictions on business and travel removed, the epidemiologist and hospital executives from the Texas Medical Center said the only hope for the Houston area to avoid that outcome is for residents to practice social distancing, wear masks and avoid unnecessary contact with others.

Too many residents, they said, appear to have mistaken the end of Harris County’s stay-at-home order as a cue to resume normal life, while the virus poses a greater threat today than it did on May 1.

“The alarming situation could be that we have rampant COVID spreading throughout our society,” Houston Methodist CEO Dr. Marc Boom said. “If we don’t take control, it takes control for us.”

See here for some background. Hey, remember that May projection from the PolicyLab at Children’s Hospital of Philadelphia that was based on social distancing data? It suggested we would get up to over 2,000 hospitalizations per day, right around where we seem to be headed now. Their graph had us hitting that mark in early June, while Baylor is suggesting July. Never would have been much better than late, but here we are anyway.

Elected officials and their public health experts are grappling with the idea that Harris County may have squandered much of this spring’s success in slowing the growth of the virus during the six-week stay-home period.

The shutdown dealt severe damage to the economy, including half a million lost jobs. Since Gov. Greg Abbott began reopening the state in May, however, the Houston area has set new records for cases and hospitalizations.

“All of the good work that we did, shutting down, closing conferences and conventions … we’re wiping away the success that we collectively achieved, and the sacrifices that people made in March, April and in May,” Houston Mayor Sylvester Turner said.

The mayor lamented that local officials have had little authority to issue restrictions since Abbott has implemented his phased reopening plan, and urged residents, at a minimum, to follow County Judge Lina Hidalgo’s mask order, which went into effect Monday. The order mandates that Harris County businesses require their customers to wear face coverings.

Abbott defended his strategy during a news conference in Austin, saying it achieved its primary goal of preventing hospitals from being overrun. He said the rate of new cases across the state was unacceptable, however.

See here for more on that mask order, which we could have had weeks ago had it not been for Abbott’s ridiculous, cowardly refusal to talk straight. This is all on you, Abbott. I hope the knowledge of your craven behavior haunts you for the rest of your days. I hope even more it’s what finally forces you out of office in 2022. May we all end up being overly panicked about this, because if not this is really going to suck. The Chron editorial board has more.

The reopening metric we should be heeding

From Twitter:

Here’s that link:

Abstract

We report a time course of SARS-CoV-2 RNA concentrations in primary sewage sludge during the Spring COVID-19 outbreak in a northeastern U.S. metropolitan area. SARS-CoV-2 RNA was detected in all environmental samples and, when adjusted for the time lag, the virus RNA concentrations were highly correlated with the COVID-19 epidemiological curve (R2=0.99) and local hospital admissions (R2=0.99). SARS-CoV-2 RNA concentrations were a seven-day leading indicator ahead of compiled COVID-19 testing data and led local hospital admissions data by three days. Decisions to implement or relax public health measures and restrictions require timely information on outbreak dynamics in a community.

Introduction

The most common metric followed to track the progression of the COVID-19 epidemic within communities is derived from testing symptomatic cases and evaluating the number of positive tests over time.1 However, tracking positive tests is a lagging indicator for the epidemic progression.2, 3 Testing is largely prompted by symptoms, which may take up to five days to present4, and individuals can shed virus prior to exhibiting symptoms. There is a pressing need for additional methods for early sentinel surveillance and real-time estimations of community disease burden so that public health authorities may modulate and plan epidemic responses accordingly.

SARS-CoV-2 RNA is present in the stool of COVID-19 patients5-7 and has recently been documented in raw wastewater.8-10 Thus, monitoring raw wastewater (sewage) within a community’s collection system can potentially provide information on the prevalence and dynamics of infection for entire populations.11 When municipal raw wastewater discharges into treatment facilities, solids are settled and collected into a matrix called (primary) sewage sludge, which has been shown to contain a broad diversity of human viruses including commonly circulating coronavirus strains.12 Primary sludge provides a well-mixed and concentrated sample that may be advantageous for monitoring SARS-CoV-2. As viral shedding can occur before cases are detected, we hypothesize that the time course of SARS-CoV-2 RNA concentrations in primary sewage sludge is a leading indicator of outbreak dynamics within a community served by the treatment plant.

So in plain English, if you know what the level of SARS-CoV-2 is in your municipal wastewater, you will have a very accurate predictor of the new COVID-19 case rate in your community. And guess what? The city of Houston is tracking this very data. I don’t know if it’s being published anywhere, but it sure could shed some light on how things are really going around here. Other cities should be doing this as well – if they aren’t doing it already, they need to start – and that information should be collected and published at the state level as well. What are we waiting for?

From the “Shit happens” department

I apologize, I couldn’t help myself.

City health officials and Rice University scientists have begun testing Houston wastewater samples for COVID-19, a process they hope will reveal the true spread of the new coronavirus as clinical testing continues to lag.

The city-led effort makes use of studies that show traces of the virus can be found in human feces. By testing samples of sewage collected at the city’s wastewater treatment plants, officials hope to uncover the scale of the outbreak in Houston and, perhaps, locate hotspots undetected by in-person tests.

“It’s an evolving field. We hope that it will help give us just more information on where the virus is and how much of it is out there,” said Loren Hopkins, a Rice University statistics professor who also serves as the health department’s chief environmental science officer.

[…]

For now, plant workers are collecting wastewater samples across a 24-hour period once a week, before sending them to Rice and health department officials who then analyze the samples for COVID-19, the illness caused by the new coronavirus.

If successful, the project will reveal COVID-19 trends over a span of weeks and months in certain areas of Houston and citywide, Hopkins said. Though less precise than directly testing people for the coronavirus, the analysis will produce case estimates that include people who lack symptoms, because asymptomatic people still shed the virus in their stool. And because workers at the treatment plants are collecting samples across a 24-hour period, the results may provide a more accurate snapshot than the number of positive in-person test results, Hopkins said, because that data is impaired by days-long delays in receiving results.

Where the data may prove especially useful, experts said, is in locations where wastewater samples indicate the virus has spread more widely than clinical testing has revealed. Officials can then direct more testing to those areas, including through a mobile unit that launched earlier this week.

This is an attempt to address the serious gap between our need for testing and our capacity for testing. We hope it will help identify trends and emerging hot spots more quickly and effectively. It’s something that’s not been done before, and who knows if it will work the way we want. It’s surely worth a try.

Last minute health insurance enrollment help

From the inbox:

It's constitutional - deal with it

It’s constitutional – deal with it

The Houston Department of Health and Human Services (HDHHS) will open four of its multi-service centers on Sunday and extend their business hours next Monday to help people sign up for a health insurance plan by the Affordable Care Act’s March 31 deadline.

HDHHS will open Acres Homes, Denver Harbor, Northeast and Southwest multi-service centers on Sunday, March 30, from 12 p.m. to 6 p.m. It will also extend the four multi-service centers’ business hours on Monday, March 31, until 10 p.m., setting the last ACA enrollment appointment for 8 p.m.

Approximately 99,000 Houston-area residents have enrolled in one of the more than 40 low-cost ACA health plans available in the region. Those without health insurance have only one week left to sign up.

Residents can set up an appointment for one-on-one help from certified application counselors at HDHHS by calling 832-393-5423. The counselors are able to help residents compare health plans and find one that fits their budget and health care needs.

The phone number connects residents to an ACA call center that HDHHS set up as part of the Gulf Coast Health Insurance Marketplace Collaborative, a group of 13 agencies helping people obtain insurance coverage through the ACA.

Certified application counselors and outreach staff with HDHHS and the other agencies in the collaborative have met face to face with more than 151,500 area residents since the enrollment period began in October. They have also reached out or distributed ACA brochures and information to approximately 538,000 people.

Documents needed to enroll during an appointment include:

  • Proof of U.S. citizenship: social security number or copy of U.S. passport for all family members
  • State residency: driver’s license, housing lease or utility bill
  • Income:  W-2 forms or pay stubs; unemployment or disability; social security, pension and retirement income; or copy of 2012 tax return
  • Current health insurance: policy numbers for any current health insurance and information about job-related health insurance
  • Immigration status or legal residency: Immigration document status numbers.

The press release is here, and Stace was also on this. There are going to be a number of rallies and other events aimed at getting people signed up while they still can. Another event, via State Rep. Jessica Farrar, will be Saturday, March 29th from 9:00 a.m. – 1:00 p.m. at the Harris County Department of Education Conference Center, 6300 Irvington Blvd. Anyone who has questions about the exchange or is currently without health insurance is encouraged to attend. Here’s a Trib story about the pre-deadline push.

The Affordable Care Act requires most individuals to purchase health insurance by 2014, specifically by March 31, which will mark the final day of canvassing and enrollment outreach by nonprofits, local governments and community organizations.

At the start of March, 295,000 Texans had selected a coverage plan in the federal marketplace, but the number of total enrollees represents a small fraction of the uninsured in Texas.

National advocates for health reform have homed in on Texas’ enrollment in recent weeks, including U.S. Secretary of Health and Human Services Kathleen Sebelius, who was in Texas last week to promote enrollment efforts, including a final push to mobilize young adults to sign up for insurance through the marketplace.

Enroll America, a nonprofit group promoting the federal health reform law, launched a six-city bus tour through Texas last week to help people enroll in the exchange. Anne Filipic, president of the group, said it has focused on Texas because of the amount of people “who stand to benefit” from the federal health reform.

The organization has also set up a series of enrollment events throughout the state, including the one Donnell attended, as part of the final week of enrollment and is following up with individuals who started their process at one of the events to help them complete their enrollments.

Locally, state Democratic legislators have hosted their own enrollment efforts or have worked with entities like the Texas Organizing Project, a group that advocates for low-income Texans, to host regular enrollment events in Dallas, Bexar and Harris counties.

Federally qualified health centers in Texas also received more than $15 million federal grants to help individuals enroll in the marketplace. Lone Star Circle of Care clinics was among the top recipients in the state, receiving a combined $600,000 in grants to provide enrollment assistance.

Lone Star spokeswoman Rebekah Haynes said its 35 certified application counselors have seen an uptick in demand for enrollment assistance in the last few weeks, and they are working with hundreds of individuals to verify whether they qualify to purchase health insurance through the marketplace.

Texas could have delivered half of the enrollees the Obama administration is banking on. The Kaiser Family Foundation estimates that 3,143,000 Texans are potential marketplace enrollees, but only 9.4 percent of that population has enrolled. (Potential enrollees include uninsured Texans who are U.S. citizens and have incomes above the amount needed to qualify for Medicaid.)

You have to wonder what might have been if anyone in the Republican leadership cared even a little bit about the vast number of uninsured people in Texas. Be that as it may, if you know someone who needs coverage but still hasn’t signed up yet, do whatever you can to encourage them to get it done now. Time is very much running out.