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Methodist Hospital System

More COVID restrictions are about to happen in Harris County

Blame Greg Abbott and the virus, in whatever order you prefer.

Houston and its surrounding communities on Tuesday became the latest region to require new emergency restrictions after seven straight days of ballooning coronavirus hospitalizations.

The rollback, mandated under Gov. Greg Abbott’s emergency protocols, includes restaurants dropping to 50 percent occupancy from 75 percent, and bars that have not reclassified as restaurants closing immediately. The restrictions remain in place until the region drops below 15 percent COVID-19 hospitalizations for seven straight days.

As of Monday, the latest day of available data, the Houston region was at 19.9 percent, up from just over 13 percent a week earlier. Infections and hospitalizations have been rising steadily in recent weeks, following spikes in other parts of the state and amid holiday gatherings.

All but four of the state’s 22 hospital regions were over 15 percent as of Monday.

Texas Medical Center Hospitals in Houston announced earlier Tuesday that they were putting a hold on certain elective surgeries to save resources for coronavirus patients. Under the governor’s protocols, hospitals are required to postpone elective surgeries that would deplete COVID-19 resources.

“The best thing we can do is take this threshold as a wakeup call,” Harris County Judge Lina Hidalgo said in a news conference Tuesday afternoon. “This is the time to take this for the red alert that it is. We are only going to get through this if we are able to quickly stem the tide of hospitalizations.”

More here.

The rollback comes as Texas Medical Center hospitals already had begun deferring certain elective procedures or readying such a managed reduction strategy, the same one they deployed during the summer when patient censuses spiked. The reduction is not the wholesale delay of elective procedures all Texas hospitals invoked in the spring.

Hospital leaders said Tuesday their systems will continue some elective procedures but suspend those non-urgent cases whose demands on staff and space detract from resources better used to treat COVID-19 patients. Procedures such as mammography and colonoscopy will continue because they don’t tax needed hospital resources, for instance, but some procedures like heart catheterizations might be better delayed.

[…]

The surge of COVID-19 hospitalizations has been relentless. The number of admitted COVID-19 patients in the Houston region has increased for 13 straight weeks, and the 25-county area anchored by Harris County had more than 3,100 hospitalizations on Monday, the highest since July, the peak of the first wave in Texas.

Houston Methodist was just short of 700 COVID-19 patients on Monday. Methodist CEO Dr. Marc Boom emailed employees that if this trend holds the system will surpass its peak July numbers in a matter of days.

“This may well be among the most challenging few weeks we’ve experienced during this pandemic,” Boom wrote in the email to employees Monday. “Together, we will get through this, but it will be difficult.”

Dr. James McCarthy, chief physician executive at Memorial Hermann, said his system exceeded 800 patients and should eclipse July numbers by the third week in January. The system’s number of patients has increased three-fold over the last month, he said.

[…]

The COVID-19 positive test rate statewide is now at 20.53 percent. Methodist’s is nearly 32 percent.

Porsa said said Harris Health is about to enter Phase 3 of its surge plans, which involves closing some of its clinics in order to deploy its nurses and other staff at Ben Taub and Lyndon B. Johnson hospitals, both of which are near capacity. He said the leadership is currently determining which clinics to start with.

Hospital officials said they are encouraged that ICUs aren’t being overloaded with COVID-19. They said their staffs have gotten much better, thanks to better treatment options and nine months of experience with the disease, at getting patients discharged faster now compared to early summer.

But with the Houston area now averaging more than 3,300 new COVID-19 cases a day — compared to roughly 2,330 such cases at the pandemic’s height in July — it appears the peak won’t come before late January or February, hospital officials said. They also worry a more contagious strain — not yet identified in Houston but maybe already here — poses an even greater threat ahead.

“January and February are shaping up to be our darkest days, given these record numbers,” said William McKeon, CEO of the TMC. “Hospitals lag behind in feeling the effects of increases in cases so expect the numbers to keep going in the wrong direction before things get better.”

We’re already passing the levels we had seen at the worst of it in July, and we’re probably a few weeks out from hitting the peak this time around. Remember all this next year, when it’s time to vote for our state government.

It’s still not too late to prevent a big spike in COVID infections

But it will be soon.

A rise in COVID-19 cases has health care officials and government leaders pleading with Houstonians: Act now to prevent, or at least minimize, a third wave of infections across Greater Houston.

“This feels a lot like late May, early June when we saw the early warning signs that things were beginning to increase,” Dr. Marc Boom, president and CEO of Houston Methodist, told the Chronicle on Tuesday, “and then things slipped out of our control.”

According to a Chronicle analysis, the seven-day rolling average for newly reported cases was 1,044.2 as of Monday in an eight-county Houston area. That’s the highest since Oct. 8. In the summer, the rolling average peaked July 17 at 2,432.7.

The rate at which the virus is spreading, called the reproduction rate, reached 1.18 across a nine-county Houston area as of Monday, according to the Texas Medical Center. A number below 1, which the Houston area did report for a few weeks, means the virus is burning out. A number above 1 means that virus spread is increasing. During the COVID-19 spike this summer, Houston’s reproduction rate was in the 1.5-1.7 range when things were getting out of control, Boom said.

Finally, the seven-day average for COVID test positivity rate was 4.2 percent for TMC hospital systems as of Monday. It had been 3.4 percent last month.

For the city, Mayor Sylvester Turner on Monday reported the positivity rate was 6.5 percent as of Oct. 21. Statewide, the positivity rate was 9.42 percent as of Monday.

[…]

Houston-area case increases are not as severe as in other parts of the country and state. In the U.S., 489,769 new cases have been reported since Oct. 20. There are surges in Wisconsin and other Midwest states. In El Paso, state health officials converted a convention center into a makeshift hospital to ease the crush of patients.

Still, Shreela Sharma, an epidemiologist at UTHealth School of Public Health, knows how quickly COVID cases can climb. And she said the number of new cases in the Houston region is roughly 40 percent higher than when the summertime peak began. That means if a third wave does occur, it would start with a higher baseline.

The time is now to wear masks, practice social distancing and wash your hands.

“Our window is right now,” she said. “We could rapidly lose that window over the next few weeks.”

Yes, that is the one piece of good news. We know how to get a handle on this, and we’ve been doing it all along. Wear your mask – yes, wear it while voting, too – maintain social distancing, and avoid indoor gatherings. This week’s colder weather excepted, we’re in much better shape to handle the winter than the northern climes, because for most of our winter it’s still perfectly amenable outside for activities and dining and whatnot. Again, just don’t be an idiot. Do the things that you know you need to do. The alternatives are so, so much worse.

One more thing:

Researchers with Houston’s Health Department will monitor the wastewater flushed from 60 schools and 15 senior living homes in the city for COVID-19 in hopes of catching outbreaks before they arise in clinical testing.

City council on Wednesday unanimously approved $11.5 million in federal COVID-19 spending. Included in that was $221,000 to buy the sampling equipment needed to expand the city’s existing wastewater testing program into K-12 schools in areas with high positivity rates.

People shed the novel coronavirus through feces, regardless of whether they experience symptoms. The samplers will be installed in manholes outside the schools, and researchers will analyze them, looking for the virus.

“It’s very granular,” said Dr. Loren Hopkins, the health department’s chief environmental science officer. “We don’t expect to see any positives at all, we expect to see nothing… If we see something in a school and we see it two days in a row, then we know someone in that school is shedding the virus.”

The department would then alert the school and deploy the more traditional, clinical testing, according to Hopkins.

Don’t laugh, this is an effective method of contact tracing. It’s already been used successfully by the city. Now, if there are people who can test wastewater to see if your poop has the COVID virus in it, you can damn sure keep wearing your mask.

“On the cusp” of another COVID surge

The numbers are already trending up. You know what that means.

Cases of COVID-19 in parts of Texas surged to near catastrophic levels this summer as some hospitals were forced to put beds in hallways, intensive care units exceeded capacity and health officials struggled to stem the tide of the virus.

After peaking in late July and August, cases fell and leveled off in September, and the state’s seven-day positivity rate — or the proportion of positive tests — reached its lowest point since early June.

But health officials are now eyeing a worrying trend: New infections are rising again, and the number of patients hospitalized with COVID-19 is also ticking upward. The state reported 2,273 new cases Monday, and the seven-day average was up by 862 from the previous week. On Monday, at least 4,319 patients were hospitalized with COVID-19, far below the more than 10,000 in July, but that number has steadily risen during the last month.

“I’m no longer pondering if we’re going to see a surge,” said Dr. James McDeavitt, dean of clinical affairs at the Baylor College of Medicine. “We’re already seeing it.”

Eight months since Texas recorded its first case, experts say the state is more prepared to handle another wave, but they fear that if the state fails to control the outbreak, it could quickly spiral out of control.

“The question is whether it’ll be a modest surge, or something like we saw in July, or worse,” McDeavitt said.

[…]

At Houston Methodist, one of the region’s largest health care systems, medical staff were stretched thin this summer, said President Marc Boom. At its peak in July, the system’s staff treated nearly 850 patients with COVID-19 each day. Since then, Boom said, the medical community’s understanding of the virus has evolved, along with how to treat the disease.

Remdesivir, an antiviral medication, has shown promising results in minimizing the severity of illness, especially when administered shortly after symptoms develop. Houston Medical was the first hospital to use convalescent plasma, a therapy in which antibody-rich blood from people who have recovered from COVID-19 is administered to ill patients, Boom said.

“We’ve had tons of experience gained, better outcomes, shorter lengths of stay,” Boom said. “But this is still a serious illness.”

While health authorities are better equipped to deal with new spikes, including an adequate supply of protective gear and sizable quantities of drugs like Remdesivir, a fall surge could still be equally as taxing on hospitals, said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association. As colder weather forces people inside and families gather for the holiday season, the chances for transmission increase, she said.

“We certainly have been tested, and we know the beast that it is, and have shown that we were able to make it through those first two spikes,” Kroll said. “But we don’t want to test the limit by putting patients into hospitals.”

See here for the previous update. It’s getting bad all around the country, too. Just a reminder, the July surge was bad, and it took Greg Abbott way too long to react to it. In the meantime, various assholes have decided that it’s a good use of their time to sue everyone in sight to limit the government’s ability to respond to COVID-19. I have one small bit of local optimism in that Harris County has not backed down from being at the top threat level even as the numbers were improving. Our numbers are also trending up, but they’re not as bad as other places. Yet, anyway.

“The trends are going in the wrong direction,” said William McKeon, president of the Texas Medical Center. “You hate to see the sacrifices we made and the successes we achieved lost because people let their guard down.”

Dr. Marc Boom, president of Houston Methodist, said, “We’ve definitely turned the wrong corner. The numbers aren’t growing in an out-of-control fashion, but there’s no doubt we’re in a significant growth trend that we need to stop before the holiday season.”

[…]

The Houston numbers are well below those in other parts of the country, particularly the Midwest and the West. As of Monday, 16 states had added more COVID-19 cases the past week than in any other seven-day period.

The surge is even greater in Europe. There the total of new cases in the five most-affected countries — France, the United Kingdom, Russia, Spain and the Netherlands — was nearly 42 percent greater than the U.S. increase a week ago.

Nor does Houston’s increase compare to the Panhandle and El Paso. El Paso health officials Monday reported their highest number of COVID-19 hospitalizations since the pandemic began — 449 in one day — and said just seven of the city’s ICU beds were unoccupied.

Still, increases in Houston area’s key metrics since early October are cause for concern, said local health officials. Those provided by the Texas Medical Center include:

• The rolling average of 497 COVID-19 cases reported the week ending Sunday represents a 33 percent increase from late September, when the number was 373. It increased gradually the weeks in between.

• The number of COVID-19 patients admitted to TMC hospitals exceeded 100 last week, up from the 80s the previous week and 70s the week before that.

• The TMC COVID-19 test positivity rate, 3.4 percent early in October, has been at 3.9 percent the past week, an 8 percent increase.

• The so-called R(t), or reproduction rate, the rate at which the virus is spreading, did drop to 0.99 Tuesday, but that remains a 55 percent increase over the Sept. 29 rate of 0.64, when the spread was decreasing. The rate last week hit 1.14, which means the virus’ spread was increasing.

“We’re in a yellow zone, not a red zone”, is how one doctor put it. “COVID fatigue”, they say this is. I get that, but you can see what happens when we start to take this less seriously. Until there’s a widely available vaccine, wear your damn mask, stay out of crowded indoor spaces, maintain social distancing, and hope for the best. At least our mild winter weather means we can largely stay outside. It could be worse.

No smokers need apply

Boy, is this a big can of worms.

Methodist Hospital System in Houston this month announcedit will implement a tobacco-free hiring policy on Jan. 1, joining the Texas Medical Center and Memorial Hermann Healthcare System, which have had similar policies since last year and 2010, respectively.

The policies are straightforward. Applicants who smoke or chew tobacco will not be hired. Existing employees are exempt.

A growing number of hospitals and health care institutions have adopted the policies to promote wellness, improve productivity and rein in rising health care costs, but critics say they discriminate and could lead to punitive actions against other personal habits and vices.

“We think this is an invasion of privacy and really overreaching,” said DottyGriffith, public education director for the American Civil Liberties Union in Texas. “At what point do you give up your rights and autonomy? Will they not employ those who ride motorcycles and drink alcohol?”

Dr. Marc Boom, president and CEO of Methodist Hospital System, said the policy is about company employees modeling healthy behaviors. More than 13,000 people work at the system’s five hospitals.

“This is part of a journey of wellness and making this a great place to work,” Boom said. “Employees work here to take of care patients. We can only do that if we’re leading by example.”

Methodist’s online application will warn job seekers that it is a tobacco-free employer and that urine tests will be used to detect nicotine. A job offer will be rescinded if an applicant’s results are positive. Free smoking cessation classes will be offered, giving applicants an opportunity to reapply if they have been smoke-free for 90 days.

On the one hand, it makes perfect sense for a hospital system to practice what it preaches. There’s a lot to be said for leading by example. And, though it isn’t specifically mentioned in the story, having an entirely non-smoking workforce would be great for Methodist’s bottom line, since it would reduce their own health care costs. Therein lies the rub, of course, because if having a non-smoking workforce is good for the company, then so is having a non-overweight workforce, and who knows what else. Employers have enough power over their employees already, thanks very much. Be that as it may, I have a strong feeling this will ultimately be settled in a courtroom, after someone files suit for discrimination. What do you think?