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Peter Hotez

We are not ready to re-reopen

I don’t know who needs to hear this, but…

Texas COVID-19 hospitalizations have declined the most significantly — 4,144 Tuesday, down from 10,893 on July 22 — but new cases, positive test rates, daily deaths and viral spread are all dropping. They are dropping enough that one Texas modeler, Spencer Fox of University of Texas at Austin, went so far as to say he thinks that Texas may have seen the worst of the pandemic — as long as people continue to wear masks and keep their guard up.

A number of other health experts warned against lifting restrictions, noting that the coming Labor Day weekend, the expected resumption of schools and seasonal weather changes have the potential to cause a resurgence like Texas experienced earlier in the summer. They also said the amount of transmission, although improved, is still way too high.

“I don’t want to be Debbie Downer, but we’ve been surprised before,” Catherine Troisi, an infectious disease epidemiologist at the UTHealth School of Public Health, said last Friday. “It’s a double-edged sword when things start looking better. The virus is still out there, but people think things can go back to normal.”

Troisi added that some experts are hesitant because of the state’s data reporting problems, because it’s possible some other issue will surface. Those problems include under testing, coding errors that caused backlogged results and combining positive diagnostic and antibody tests.

Chris Amos, a Baylor College of Medicine quantitative scientist, said “the timing could not be worse for rolling back.”

“Given the number who test positive reflect perhaps 10 times as many individuals who have not been tested but are positive,” said Amos, “there remains a large pool of individuals who can spread COVID-19 if they begin interacting with many others, and particularly if we allow large groups to start coming together again.”

Amos acknowledged that optimism about opening up is natural given the slowing of COVID-19’s spread. The spread is measured by a value, known as reproductivity, that suggests a slowing or growing of the virus. Over 1 means each infected person transmits it to an average of more than one person and the epidemic grows; under 1 means the virus is transmitted to less than one person and the epidemic won’t sustain itself.

The value for the state overall has been under 1 since July 20.

According to Amos’ calculations, if the state maintains the current trend, with the number around 0.87, it would take 38 days to reduce the COVID-19 burden by another 50 percent.

It’s important to keep reducing that burden before students resume in-person classes, Amos said. He and others advised against a one-size-fits-all approach.

“Not every community or county in Texas is experiencing the same burden of disease,” said Angela Clendenin, an epidemiologist with the Texas A&M School of Public Health. “In some places, it may be justified to roll back some restrictions whereas in others, it’d be ill-advised to do so. It will be critically important that rolling back restrictions does not send the message that we are somehow ‘all clear.’”

See here for the background. The basic fact remains that we are still at levels well above where we were in early June, when we first re-opened. There’s no question that if we re-reopened like we re-opened the first time around, we will get the same result. To me, three things are clear. One we shouldn’t change anything until we are back at early-June levels. Two, we should have sensible objective metrics that we can actually measure with accuracy and that we stick to, unlike the first time around. And three, give some discretion back to local jurisdictions so that the counties with a sufficiently low infection rate can be more open (though still within state guidelines) while those that aren’t ready for that kind of openness can continue to do what they need to do to get there. All of this should be screamingly obvious after what we just went through, but I see no reason to believe that Greg Abbott or Dan Patrick have learned anything from that experience.

Coronavirus and hurricane shelters

Two things we have to be thinking about today.

Houston officials and public health experts are expressing concern that Tropical Storm Laura could amplify the spread of COVID-19 by displacing residents to public shelters or residences outside the area, increasing opportunities for transmission.

With that scenario in mind, Mayor Sylvester Turner on Sunday encouraged Houstonians to get tested for COVID-19 before the storm makes landfall. Forecasters have predicted it will come ashore late Wednesday or early Thursday, though the path remained uncertain by Monday evening.

Officials from Harris County and the American Red Cross began preparing for potential shelter needs months ago, County Judge Lina Hidalgo said Monday. At Red Cross shelters, officials will provide face coverings, conduct health screenings and follow federal social distancing guidance, the organization announced in a news release. It also will operate more shelters with a reduced capacity in each.

“This is not a situation where we would have the same kind of shelters we’re used to, where it’s completely open space and no division between folks,” Hidalgo said.

Turner, who urged people to get tested on Monday or Tuesday, tweeted, “You need to know your status for yourself, family members and friends.”

[…]

Dr. Peter Hotez, an immunologist at the Baylor College of Medicine, said that while disaster officials may come up with creative solutions to help contain the spread of COVID, public shelters would be “a nightmare even under the best circumstances.”

The effect may be especially pronounced, Hotez said, because those most likely to seek shelter in a public setting come from low-income communities where people are more vulnerable to the effects of COVID due to the prevalence of underlying health conditions.

It also would be difficult for contact tracers to follow the spread of the virus during an evacuation, he said.

“If you think about it, without a vaccine, what do we have? We have masks, we have contact tracing and social distancing — which are not great, but it’s all we have,” Hotez said. “With a hurricane, we’ve knocked out two of our three pieces of artillery equipment.”

These are obviously not the best of circumstances. Tropical Storm Laura is now officially Hurricane Laura, and it’s already a pretty strong one. Jefferson County, Chambers County, Orange County, and Galveston County are under mandatory evacuation orders, with parts of Harris County issuing a recommendation that areas in the storm surge zone evacuate as well.

Harris County officials urged residents of some coastal areas to evacuate Tuesday as Hurricane Laura could strike the Houston region Wednesday evening.

Harris County Judge Lina Hidalgo issued a voluntary evacuation order Tuesday afternoon for zones A and B and urged residents to leave immediately. She warned of a storm surge of three to five feet and high winds that could knock out power.

“All of us need to be prepared for the very real potential of a direct hit from this storm,” Hidalgo said. “Of course, we hope for the best, but we don’t want to find ourselves unprepared for the worst case scenario.”

These zones include part or all of Deer Park, La Porte, League City, Friendswood, Seabrook, El Lago, Morgan’s Point and southeastern portions of the city of Houston.

[…]

Houston Mayor Sylvester Turner warned residents of congested traffic on freeways heading away from the coast and urged non-evacuating residents to avoid traveling if possible. Residents in the evacuation zone should not delay, he stressed, because Laura could change course unexpectedly.

“At this point in time, if it veers further to the west and becomes more of a direct hit on Houston-Harris County, we don’t really have a lot of time,” Turner said.

The mayor urged residents to be prepared for extended power outages, and noted that some households were without electricity for two weeks after Hurricane Ike in 2008. He said people should be off the streets by 8 p.m. Wednesday, but stopped short of calling for a curfew.

Immediate safety concerns take precedence over more theoretical longer-term safety concerns. In the meantime, we prepare for the worst and hope for the best. As of last night, it looks like the worst will probably (though not 100%) miss Houston, but that means Beaumont and Port Arthur are directly in its crosshairs. We’re going to need to mobilize a strong response, because it’s going to be bad.

As a programming matter, it is certainly possible that power and/or Internet outages will have an effect on my publication schedule. That’s a pretty minor consideration, but I wanted to note it just in case. Stay safe, everyone.

Our vaccination rates are down, too

I wish I had a snappy intro for this, but I just don’t.

The summer months are typically the busiest of the year in Dr. Kenya Parks’ office, a steady flow of parents trotting in their little ones to receive immunizations required for school attendance.

But the numbers are way down this year, one more casualty of the COVID-19 pandemic.

“It’s quite noticeable,” said Parks, a pediatrician with UTHealth and UT Physicians, the practice of doctors at the University of Texas’ McGovern Medical School in Houston. “Parents who usually pack our offices around now instead are putting off or canceling or just not showing up for appointments. They’re scared.”

Such fear is a primary reason for an average 44 percent drop in the number of doses administered in the Texas Vaccines for Children program during the early months of the pandemic, according to a new state report. The trend puts Texas at risk of vaccine-preventable disease outbreaks, a potential disaster when school starts up.

The drop is particularly high for immunizations for measles — 55 percent — the highly infectious disease declared eradicated in the United States 20 years ago but now experiencing a resurgence. The drop in doses administered is slightly higher in the Houston area, site of a measles outbreak in 2019 and identified in a study the same year as one of the nation’s hot spots, vulnerable to an even bigger outbreak.

The overall Texas trend is concerning because the state’s vaccination rates were bad even before the pandemic. The state last year failed to meet minimal national goals for eight of 11 immunizations and barely squeaked by for the three it did meet.

“It’s like we got an F in eight classes and a D- in three, and now things are getting worse, when we can least afford it,” said Allison Winnike, president of the Immunization Partnership, a Houston-based vaccine advocacy organization. “That’s why it’s crucial parents call their pediatricians, get their kids in for their vaccinations if they’re not up to date.”

The good news, if you want to call it that, is that this doesn’t seem to be the result of changing attitudes about vaccinations. It’s about fear of the virus, which is something we can be a bit more hopeful will change in the not-too-distant future. But this is also a real risk factor for reopening schools, which I haven’t seen any official acknowledgement of. Risking a COVID-19 outbreak to force in-person school at a predetermined date is bad enough. Risking a measles outbreak on top of that is even worse. You can blame the parents if you want for the decisions they’ve made – I for one would be more compassionate, but you do you – but that doesn’t change the fact that this is a thing that will need to be dealt with, and that’s likely going to require some time. Are Greg Abbott and the TEA even thinking about this?

We need to understand what we did wrong

So yeah, we need this.

Two of the nation’s most influential experts on the coronavirus pandemic, both based in Texas, are calling for an independent, nonpartisan investigation of the U.S. response to the novel coronavirus.

“We must prevent this from happening again,” said Gerald Parker, who directs the pandemic and biosecurity program at Texas A&M’s Bush School of Public Service. “This is not going to be our last pandemic.”

Peter Hotez, a Houston-based vaccine researcher and frequent commentator on cable news, noted that the current virus, SARS-CoV-2, is the third coronavirus to pose a major health threat in the last 20 years. And given that outbreaks had already wreaked havoc in China and Europe, U.S. public health systems were notably slow to respond.

“What hurt Wuhan was what hurt New York City,” said Hotez, “which is that virus transmission went on for six weeks before there was any public health intervention.”

In a videotaped interview with John Sharp, chancellor of The Texas A&M University System, Parker suggested an investigation modeled on the nonpartisan 9/11 Commission.

[…]

Hotez, who also participated in the interview with Sharp, said later that he feared a congressional panel would become “a political circus.” Instead he proposed a review by the National Academies of Sciences, Engineering and Medicine.

Among the questions Hotez wants answered: How, for the whole month of February, did the U.S. miss evidence that the virus was already here? Given the crowding and high number of underlying conditions in low-income neighborhoods, what was done to prepare African-American and Hispanic communities in the early days? Why didn’t the CDC have a centralized epidemiological model, including models of cities and metropolitan areas? And how can the U.S. prepare for future epidemics?

For those who are fans of comparing government to business, this is a very standard business thing to do. Call it an after-action review, or a root cause analysis, or just a plain old audit, it really is vital to learn from experiences, good and bad, so that you can understand what happened and why it happened, and what you can do better next time. I think we can all agree that there is plenty to be learned from this saga, and we all owe it to ourselves to do that. I would hope that much is non-controversial.

But let’s be real, there’s no way to do this that won’t involve politics. You can put together the bluest of blue ribbon panels, staff it with the bona fidiest of experts, and stick entirely to a just-the-facts narrative, it’s still going to be political. That’s because the single biggest actor in this drama was Donald Trump, and his influence on the decisions made at the state and local level was entirely political. Any review that doesn’t do a thorough accounting of this isn’t worth the effort. If Republicans haven’t figured out that Trump’s mishandling of this is what’s killing them in the polls right now, I can’t help them, but I would think they’d want to help themselves. If we manage to get an all-Democratic government next year (please, please), I won’t really expect Republicans to like anything such a report would say. That’s shouldn’t be the point, or anyone’s concern. Do a thorough review, get all the facts out into the open, learn everything there is to be learned, and let the chips fall where they may.

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

We’re getting there.

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

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

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

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

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

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

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

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

It’s bad, y’all.

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

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

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

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

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

Stay home.

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

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

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

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

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

UPDATE: Oh, the irony.

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

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

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

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

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

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

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

How bad is it going to get in Houston?

I’m worried, y’all.

The number of COVID-19 hospitalizations in Texas continued to reach record highs over the weekend while new cases also climbed in the Houston area.

The new figures come as County Judge Lina Hidalgo and leaders in other urbanized counties have issued orders mandating that businesses require customers wear face masks. Hidalgo’s order goes into effect Monday, though the latest local trends indicate masks “won’t be enough,” said vaccine researcher Dr. Peter Hotez, a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.

“My observations if this trajectory persists: 1) Houston would become the worst affected city in the US, maybe rival what we’re seeing now in Brazil 2) The masks = good 1st step but simply won’t be enough 3) We would need to proceed to red alert,” Hotez said Saturday on Twitter.

[…]

Texas on Sunday reported a 5 percent increase in hospitalizations, bringing the cumulative total to a record 3,409 patients — a figure that has more than doubled since Memorial Day. Also on Sunday, a batch of 2,726 new cases became the sixth-highest single-day increase in Texas, according to a Houston Chronicle analysis. Over the previous two days, the state reported its largest and third-largest single day increases, respectively.

The Houston region has experienced a similar trend with rising case figures. Houston Chronicle data shows that Harris County is averaging 610 new cases per day over the last week, compared to 313 new cases per day the previous week.

That’s also more than triple where we were in May. The new face mask order should help, but we may need to go into lockdown again. What are the odds Greg Abbott will acknowledge that? Even if he did, would people be willing to go along with it? This was the problem with “reopening” when we did and the way we did. We didn’t have the pandemic under control. We were moving in the right direction, but we weren’t there yet. And now we’re worse off than we were before. Who could have seen this coming?

There’s also this:

Hidalgo noted an increase in county hospitalizations last week when she issued her face covering order. Leaders of other Houston area counties continue to stay away from similar measures, despite concern from local health officials.

“Galveston County will not be issuing such an order,” Galveston County Judge Mark Henry said Sunday in a lengthy Facebook post. “Individuals and businesses need to take personal responsibility in following the recommended best practices in slowing the spread of COVID-19… If you find that a business doesn’t appear to have taken steps that have been recommended in Governor Abbott’s reopening plan, then don’t reward them by doing business with them. It’s that simple.”

Galveston County reported its highest single-day case increase on Saturday with 142 new cases, followed by 83 new cases on Sunday. More than half of its new cases have been reported after June 1, health officials say.

In a news release, the Galveston County Health Department said the “alarming” increase is related to a lack of social distancing, not wearing face coverings and spreading the virus in families and households.

“Galveston County is at a critical juncture,” the release said, adding, “The health district strongly recommends Galveston County businesses require patrons and employees to wear a face covering, and to make face coverings available for those customers who do not have one.”

Brazoria County also has seen a major uptick in new cases, reporting three of its largest single-day increases over the last four days. Health officials reported 52 new cases on Sunday, bringing the overall total there to 1,215.

Brazoria County Judge Matt Sebesta as of Sunday had not issued a mandatory mask order for businesses.

We went through this back in March, too, where suburban areas around big urban centers had a very different response to the early stages of the pandemic. Please tell me we’ve learned something since then.

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

Gov. Greg Abbott on Monday struck a newly urgent tone about rising coronavirus numbers in Texas but said “closing down Texas again will always be the last option.”

“To state the obvious, COVID-19 is now spreading at an unacceptable rate in Texas and it must be corralled,” Abbott said during a news conference at the Texas Capitol in Austin.

However, he stopped short of introducing any new policies or pulling back on the reopening of Texas businesses, instead emphasizing long-established voluntary guidelines encouraging people to stay home if they can, use hand sanitizer, keep six feet of distance with others and, if they cannot, wear a mask. He also promised Texas has strategies to address the rising numbers “without having to return to stay-at-home policies.”

Those strategies include stepping up enforcement of current guidelines in places like bars where large crowds have gathered, “surging testing in areas that may be hotspots” and working with hospitals to ensure they have capacity for coronavirus patients. He continued to describe hospital capacity as “abundant.”

At the same time, Abbott held open the possibility that Texans could see new restrictions to get the virus under control. He said so while speaking in front of three poster boards showing the rapid rise of daily new cases, hospitalizations and the positivity rate, or the ratio of confirmed cases to tests.

“In each of these three categories, there’s been pretty much a doubling of the numbers in those three categories,” Abbott said. “If we were to experience another doubling of those numbers over the next month, that would mean we are in an urgent situation where tougher actions will be required.”

[…]

At the same time, Abbott continued to resist the idea of a statewide mask mandate, saying there needs to be flexibility for different parts of the vast state. He has restricted local governments from mandating individuals wear masks but recently clarified that they can order business to requires customers to wear masks.

Whatever. You had your chance to allow local governments to enforce your own orders, and you blew it. We’re still cleaning up after that. See Zeach Despart on Twitter for more.

Anti-vaxxers gonna anti-vaxx

Every step of the way, they are an obstacle to public health.

The Texas group that lobbies against vaccine mandates is now launching a campaign against COVID-19 contact tracing, the public health measure used for decades around the world to contain disease spread.

Texans for Vaccine Choice this week called on its members to contact Gov. Greg Abbott and let him know they “do not wish to be monitored or surveilled for any reason” in response to a new state program hiring and training workers to identify people who’ve come into close contact with those who recently tested positive for the coronavirus. Such people are then asked to quarantine until testing shows they don’t have the disease.

“The government should stop thinking its job is to keep everyone healthy and instead focus on protecting our rights,” says a post on the organization’s website. “We here at TFVC will remain vigilant as our government expands greatly and the threats to our members grow.”

The campaign drew an immediate rebuke from Dr. Peter Hotez, the Baylor College of Medicine infectious disease specialist who has led public health’s fight against the anti-vaccine movement, which he holds responsible for the resurgence of vaccine-preventable diseases such as measles and whooping cough.

Thanks to the movement’s efforts, some 60,000 Texas parents currently obtain non-medical exemptions for school vaccines, some 25 times higher than 2003, the first year such exemptions were allowed. A 2018 study by Hotez found Houston and three other Texas cities rank among the 15 metropolitan “Shotspots” of such exemptions.

“Awful to see the #antivax lobby in Texas now going the extra measure to halt #COVID-19 prevention,” Hotez tweeted Tuesday in reply to a Texans for Vaccine Choice tweet alerting people to the campaign. “In the name of fake ‘health freedoms’ slogans, they aspire to land thousands of Texans in our hospitals and ICUs.”

John Wittman, a spokesman for Abbott, noted that a contact tracing program was part of the guidelines laid out by President Donald Trump in order to reopen the state and has been used in Texas and the country for decades. He said the program is “completely voluntary” and that the state health department has “taken steps to ensure it protects individuals’ liberty and privacy.”

There are certainly questions to be raised about the state’s contact tracing plan, though those questions should mostly be about competence and cronyism. I can sort of see the rationale behind the anti-vaxx movement, if I squint and do some deep-breathing exercises. The point of contact tracing is to find and notify people who may have come into contact with a person who has tested positive for COVID-19. I’m really hard-pressed to see what the problem is with that, beyond the usual tinfoil-hat paranoia about RFID chips, UPC codes, and our precious bodily fluids. We already know we have a long fight ahead over an eventual coronavirus vaccine, which is now a partisan issue as well as another thing for these people to froth about. The rest of us need to recognize this for what it is, which is a direct threat to our health. What are you going to do about that, Governor?

So how’s that reopening going?

Well, there’s more of it.

Gov. Greg Abbott announced his third phase Wednesday of reopening Texas businesses during the coronavirus pandemic, allowing virtually all of them to operate at 50% capacity.

That is effective immediately, and there are “very limited exceptions,” Abbott’s office said.

Restaurants were already permitted to be open at 50% capacity. Abbott is allowing them to immediately increase their table size from six people to 10, and on June 12, they can ramp up their capacities to 75%.

Abbott’s latest order also brings news for professional and college sports that are played outdoors, letting the former shift from 25% capacity to 50% capacity at their stadiums and allowing the latter to resume for the first time, also at 50%.

“The people of Texas continue to prove that we can safely and responsibly open our state for business while containing COVID-19 and keeping our state safe,” Abbott said in a statement.

Sounds lovely. However:

The announcement came as the state sees record numbers of new daily cases of COVID-19. On Wednesday, the seven-day average for new daily cases hit 1,466, up from 1,280 in mid-May, a Houston Chronicle data analysis shows.

Abbott said nearly half of all new cases are isolated at jails and prisons, meatpacking plants and nursing homes, environments where he says outbreaks can be contained as the reopening progresses. The state has moved to increase testing at many of those locations, though testing as a whole remains stagnant, well below the governor’s goal of 30,000 tests per day. The state has averaged about 23,000 tests per day for the past three weeks.

Hospitalizations, another key measure, were down on Wednesday but have been rising steadily in the past week. They were still well below statewide capacity.

The state reported 23 COVID-19 deaths per day over the past week, down from nearly 40 in mid-May.

Abbott has said he would watch deaths and hospitalizations closely as he reopens the Texas economy.

Still, public health officials have said the state is at best plateauing, with new cases neither falling nor surging. And they have worried that the Memorial Day holiday and protests over police brutality, which have drawn tens of thousands to the street in major Texas cities, may also hasten the spread of the disease.

[…]

Dr. Peter Hotez, an infectious disease expert at Baylor College, warned last month that the state is moving too quickly.

“I understand the importance of opening up the economy,” he told the Chronicle. “The worry I have is that we haven’t put in place a public health system — the testing, the contact tracing — that’s commensurate to sustain the economy.”

I’ll get to the contact tracing in a minute, but first let’s review that hospitalization metric, because it’s always been the one metric of four that the state has actually met. But it too is going in the wrong direction.

The state reported 1,487 people hospitalized for COVID-19 on Wednesday, the lowest since April. But that figure did not include about 300 patients in the Houston area, who were omitted because of a software glitch, according to the Southeast Texas Regional Advisory Council, which collects the totals and sends them to the state.

With those patients included, the number on Wednesday was likely around 1,800, just shy of the state’s peak in early May.

Hospitalization data are one of the key measures that Abbott has said he’s watching as he allows more of the state to reopen. Virtually all businesses in the state can now operate at 50 percent of their maximum occupancy, and late next week restaurants will be able to move to 75 percent.

Lori Upton, the advisory council’s vice president of disaster preparedness and response, said the state informed it on Wednesday that a nationwide software upgrade had caused the error, lowering the preliminary count. A correction will take time because the data has to be recounted manually, Upton said.

She said technical issues are not common.

The governor’s spokesman did not respond to questions about whether the governor knew about the inaccuracy. Abbott, a Republican, has repeatedly advised against using single-day data points, explaining that weekly averages better capture trends over time.

On Friday, the seven-day average was 1,729, the highest number since the state began publishing data on hospitalizations. It has been increasing since May 27.

[…]

Though hospitalizations are up, average daily hospital admissions have been flat or slightly down over the past week, according to state data compiled by the nonprofit Texas 2036. Lauren Ancel Myer, a professor of integrative biology at the University of Texas at Austin, said that would be a positive indicator.

Myers said daily admissions in Central Texas, though, where her research is focused, have been up slightly in recent days.

“It would not be surprising at this point if we are beginning to see that the relaxation of social distancing measures, if that has actually increased the spread of the virus and has led to more patients needing hospital care,” she said.

So what happens if we do get close to the occupancy limits we have set? Well, maybe contact tracing can help with that. Oh, wait.

As Texas moves forward with a new phase of Gov. Greg Abbott’s plan for reopening businesses, the state has fallen more than 25% short of its goal for a workforce of disease detectives that experts say are crucial for tracking the spread of the new coronavirus.

One of Abbott’s reopening metrics for June 1 called for up to 4,000 Texas contact tracers, who work to identify people with possible exposure to the coronavirus and call them to get tested and self-quarantine.

But Texas officials said Thursday there were roughly 2,900 contact tracers working around the state. Of those, some 1,140 are working for the Texas Department of State Health Services, 1,170 are working for local health departments or their nonprofit and university partners, and about 600 are working for a company recently hired by the state.

State officials downplayed the importance of meeting the initial goal despite the public health agency’s statements last month assuring that health departments were in a “phase of hiring that will get us up to 4,000 in the coming weeks.”

The 4,000-person figure was an estimate taken from a national association of public health officials that was determined by the state’s population, Texas Department of State Health Services spokesman Chris Van Deusen said.

“Texas has had significantly fewer cases per capita than the national average, and we want to match the number of contact tracers to the actual workload,” Van Deusen said in an email, adding that the state has enough personnel to contact all new cases in its jurisdiction.

But other groups have suggested that Texas needs a far higher number of contact tracers. One model from George Washington University put the number at more than 8,000.

And it turns out that the firm the state gave a $295 million contract to do contact tracing is sketchy.

More than a dozen Republican legislators are bucking Gov. Greg Abbott by calling for termination of a controversial $295 million coronavirus-related contract that was hastily awarded to a company whose CEO falsely claimed he had a Ph.D.

At least two top Democrats — including the party’s leader in the Texas House of Representatives — are also criticizing the deal with MTX Group Inc., saying the state needs to demonstrate the company is up to the vital job of tracking down people who have been exposed to COVID-19, or else it should pull the plug.

The bipartisan criticism comes as the agency that oversees the contract, the Texas Department of State Health Services, acknowledges that MTX “mistakenly uploaded” job training documents to its contact tracers that they were never supposed to get, a move some lawmakers say potentially raises privacy concerns.

Another potential privacy issue: MTX workers are using their own computers and personal email addresses, fueling worries — unwarranted worries, the state says — that private medical information about the people they investigate could be inadvertently divulged.

State Rep. Steve Toth, R-Conroe, like many conservative Republicans, already had privacy concerns about COVID-19 contact tracing before MTX got the job. But he said when he learned that MTX CEO Das Nobel had falsely claimed on his online LinkedIn bio that he had a doctorate from Colorado Technical University, he moved into the end-this-now camp even as Abbott staunchly defends the emergency contract.

“Up until that point, I was like, OK, I’m not good with this, but let’s just chill and find out more,” Toth said. “That pushed me over the edge.”

I mean, look. The overall numbers are still fairly modest, and the hospitals have done well so far. Treatment has improved as we have learned more, so people are spending less time and need less intensive therapies in hospitals. It is true that a large percentage of infections are in limited locations, and the risks of various activities, mostly outdoor activities, is understood to be fairly small. My point is this: The state hasn’t met its own metrics, contact tracing is a mess, and as far as I can tell there’s no plan except “clap harder!” to deal with any significant upticks in the infection rate. If I felt better about there being a plan for if and when the curve started going up again, I’d have fewer complaints. I just don’t know what we are going to do if things do not get better but do get worse. I admit, maybe that won’t happen. But that kind of hope appears to be all we have right now. I’m worried about it because I don’t think our state leaders are worried enough about it, never mind the dumpster fire in Washington. So yeah, I’ll hope for the best. What else can I do right now?

That’s not how you test

Oops.

Texas health officials made a key change Thursday to how they report data about the coronavirus, distinguishing antibody tests from standard viral tests and prompting slight increases in the state’s oft-cited daily statistic known as the positivity rate.

The positivity rate is the ratio of the confirmed cases to total tests, presented by the state as a seven-day rolling average. The Texas Department State of Health Services disclosed for the first time Thursday that as of a day earlier, it had counted 49,313 antibody tests as as part of its “total tests” tally. That represents 6.4% of the 770,241 total tests that the state had reported through Wednesday.

Health experts have warned against conflating the tests because they are distinctly different. Antibody tests detect whether someone was previously infected, while standard viral tests determine whether someone currently has the virus.

Now that DSHS is reporting the number of antibody tests, it has recalculated its daily positivity rates starting Tuesday to exclude such tests. That led to a 0.41 percentage-point increase in Tuesday’s rate and a 0.55 point increase in Wednesday’s rate, according to DSHS calculations.

DSHS acknowledged last week that it was reporting an unknown quantity of antibody tests as part of the “total tests” figure. Despite that, Gov. Greg Abbott incorrectly claimed Monday that the state was not “commingling” the numbers while promising the state would soon break out the antibody test count.

[…]

When public health agencies combine antibody testing figures with viral testing figures, “I want to scream,” said Seema Yasmin, an epidemiologist and director of the Stanford Health Communications Initiative.

Viral tests, usually taken from nasal swabs, can detect an active coronavirus infection. If a person’s biological sample is found to have traces of the virus’s genetic material, public health workers can order them to self-isolate and track down any of their contacts who may have been exposed.

Antibody tests “are like looking in the rearview mirror,” Yasmin said, because they may show if a person has recovered from a coronavirus infection. That can be useful for public health surveillance, but it does not offer much insight about where the virus is currently spreading. Another issue is that many antibody tests have been shown to have high rates of inaccuracy, she said.

“As an epidemiologist, this level of messiness in the data makes your job so much more difficult, and it misleads the public about what’s really happening,” Yasmin said. “We’ve been talking about the capacity for testing increasing over the last few weeks, but now we might have to tell the public that might not be true.”

And dumping antibody testing data into the pool of viral testing data brings the overall positivity rate down, reflecting “a deceptive misuse of the data,” analysts for the COVID Tracking Project wrote last week. That’s because the numbers may make it seem like the state has grown its testing capacity even if a state’s viral testing capacity remains flat.

“This is crucial as we need increased capacity for viral testing before reopening to identify active infections even in the pre-symptomatic or asymptomatic stages,” the analysts wrote.

To be fair, Texas is not the only state to have done this. Florida and Georgia have been accused of manipulating their data in other ways as well. The bottom line here is that we’ll never get our arms around this pandemic if we don’t have good data. The data is messy enough as it is, we surely don’t need to be making it worse.

Are we headed towards a coronavirus spike?

One set of researchers thinks we may be.

Houston is one of several cities in the South that could see spikes in COVID-19 cases over the next four weeks as restrictions are eased, according to new research that uses cellphone data to track how well people are social distancing.

The updated projection, from PolicyLab at Children’s Hospital of Philadelphia, found that traffic to non-essential businesses has jumped especially in Texas and Florida, which have moved aggressively to reopen.

In Harris County, the model predicts the outbreak will grow from about 200 new cases per day to more than 2,000 over the next month.

“Some areas—particularly in the south—that have moved more quickly to reopen are showing a higher risk for resurgence,” the researchers wrote in a blog post. “If people in Houston and Palm Beach, Fla., for example, aren’t being cautious with masking in indoor crowded locations and with hygiene and disinfection, local governments may need to intervene again should they lose control of the epidemic.”

[…]

The PolicyLab research is tracking 389 large counties across the country with active outbreaks. It found that projections are best in places that are relaxing restrictions selectively in areas with fewer cases and less transmission.

“Given these cautious actions by our governments, we have already seen that the predicted resurgence has not occurred in most places that are beginning to reopen—rather, daily cases are either plateauing or falling,” the researchers wrote. “But the picture our models are painting for Texas and Florida provide ample evidence to others who would choose to move too quickly. We see these concerns even as we adjust for additional testing capacity that might have inflated our forecasts.”

See here and here for more on the predictions, and here for an earlier press release about their model. As far as I can tell, their model depends on “social distancing measures, defined by travel to non-essential businesses”. They say their data comes from a variety of publicly-available sources, but that’s about as much detail as I can find. I’m not an expert in any way, so I’m in no position to critique this. Fortunately, Dr. Peter Hotez is an expert, and he shared some thoughts about this in Friday’s Chron.

I understand the importance of opening up the economy. The worry that I have is that we haven’t put in place a public health system — the testing, the contact tracing — that’s commensurate to sustain the economy.

Some models show fairly dire predictions for Houston. I’m referring to the Children’s Hospital of Philadelphia model that shows that by the summer, if we’re only at about 50% of the social distancing, we’re doing now, Harris County could see a steep surge in the number of patients coming into the hospitals and intensive care units.

It’s a model. It’s only as good as the assumptions that it’s based on, and we know the assumptions are not robust. But it gives me pause for concern that unless we have that health system in place, we could be looking at an epidemic that’s far greater than the one we’ve gone through.

Let’s say we’re opening up as as we are now. The way a surge works is, it’s not as if we’re going to see a gradual increase in cases. The models say things will look good for weeks. At first, it’s a flat curve, then it’s flat, it’s flat, and only after all that do you start seeing a steep, steep increase.

That’s what worries me. In those flat weeks we’ll get this sense of complacency, and then people are going to start going into the bars. Forget about one quarter occupancy in the bars. Poison Girl, on Westheimer, is going to be full. And so are all the other places all across Houston.

So: How do we fix that? I think it’s having a health system that’s larger and more extensive than what’s being proposed. We’re going to have to do extensive testing in the workplace so that you’d know if your colleagues have COVID-19 — especially asymptomatic COVID-19.

The number of contact tracers has to be far greater than the numbers that I’m seeing. Gov. Abbott says that Texas has around 2,000 and plans to hire 2,000 more. But consider that Gov. Cuomo in New York State is hiring 17,000 contact tracers. A state that’s quite a bit smaller is hiring a much larger number.

We also still don’t have that syndromic-monitoring system in place that you and I have talked about — an app that would allow Houstonians to report how they’re feeling, or that would track temperatures, like the Kinsa electronic thermometer app.

We should be bringing in our best engineering minds out of the oil and gas industry, out of NASA, out of the Texas Medical Center to put in place an app-based system — maybe make a hybrid between the kinds of things being put out there by Apple or Google or Kinsa, or the kinds of things they’re doing in Australia. We can design one that works for our culture, works for our system. But we’re not assembling the engineers to put that in place.

We don’t even have an epidemiological model for the city of Houston. There’s one for Dallas, put out by UT Southwestern and the University of Texas. Austin’s put out one. But I haven’t seen one for Houston.

So I’m worried that if people are going to start piling into bars and restaurants, and we don’t see the numbers going up, within a couple of weeks from now, it’ll be business as usual. Everybody will feel good, will be saying, “Hey, I’m not seeing the cases go up.”

And it’s going to really accelerate starting in the fall. This is not only true of Houston; it’s true of cities across the U.S. It would happen right before the 2020 election, so I worry about a lot of instability and how we mitigate that.

So there you have it. Keep it up with the social distancing and staying at home, avoid crowds, and wear a mask. We all have a role to play.

We still have no idea how many people have been infected

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

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

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

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

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

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

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

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

[…]

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

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

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

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

Texas officials defended the state’s response.

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

The information Texans are working with is too damn thin.

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

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

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

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

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

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

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

The Houston healthcare community is preparing for COVID-19

I sure hope it’s enough.

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

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

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

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

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

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

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

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

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

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

[…]

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

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

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

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

The state responds to coronavirus

Like it or not, we need to be prepared.

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

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

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

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

[…]

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

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

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

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

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

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

Our vaccine exception rates keep going up

A small change to the law in 2003 has had a big effect over time.

As measles cases hit a 25-year high in the United States, Texas medical experts fear the state could see the next outbreak of a vaccine-preventable disease. Texas has reported 15 confirmed cases of measles so far in 2019, six more than in all of 2018.

Health officials are watching pockets of Texas closely because of the number of parents requesting exemptions under Texas’s broad vaccine exemption law. Texas is one of 16 states that allow parents to bypass vaccine requirements for enrolling their kids in school by claiming a conscientious exemption, along with citing medical or religious concerns. Just last month, Washington ended conscientious exemptions on the heels of a large measles outbreak with over 70 reported cases. Three states — California, West Virginia and Mississippi — only allow medical exemptions.

Texas’ exemption law used to be stricter. In 2003, a state senator proposed loosening restrictions via a three-page amendment to a 311-page bill. After five minutes of discussion, the amendment was approved. The bill was soon signed into law. Sixteen years later, former state Sen. Craig Estes said the change to Texas’ vaccine laws that he helped enact should be reviewed in the current public health climate.

“Obviously we didn’t ever imagine what would happen,” Estes, a Republican from Prosper, told The Texas Tribune. “With what’s happened recently, I would encourage the legislature in the future to revisit that issue and debate it.”

The speedy way in which the Texas Legislature weakened the state’s vaccine exemption rules suggests that, like Estes, few in office at the time thought it would put Texas at risk for future outbreaks. However, while experts suggest Texas is now vulnerable, efforts to change the exemption law have been dead on arrival in the Capitol.

“There will be a terrible measles epidemic in Texas, and children will be hospitalized in intensive care units, just like they are in New York right now,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said last month. “That will wake up the state Legislature to realize that there’s a problem and close those exemptions.”

Kindergarteners must have 10 immunizations to be enrolled in Texas schools. Since 2006, when the state first started reporting the data, the exemption rate for kindergarteners in Texas has risen from 0.3% for the 2005-06 school year to 2.15% for the 2018-19 school year.

In Texas, school districts, private schools and charter schools are required to report their vaccine exemption rates per vaccine. The data collection is done through a survey administered by the Texas Department of State Health Services, but some schools don’t report consistently, leaving gaps in the data.

The data shows certain communities — like the Dallas Independent School District — have seen a recent spike in conscientious exemptions for kindergarteners. Others — like El Paso ISD — have seen exemptions recently plummet. Some smaller private schools, meanwhile, have exemption rates that are significantly higher than those of other schools. The Austin Waldorf School had the highest vaccine exemption rate for the 2018-19 school year, at 52.9%. Alliance Christian Academy had the second-highest rate at 40.6%.

When enough of a community is immunized against a disease, that group has what’s known as herd immunity, meaning there is a low risk of a disease spreading. Vaccine-preventable disease have different herd immunity thresholds. Measles, which is highly contagious, has a high herd immunity threshold of 95%. According to a state report for the 2018-19 school year, Texas kindergarteners statewide had coverage levels higher than 95% for all required vaccines. Yet the data from individual school districts and private schools suggests that some communities may fall short of meeting that threshold for some vaccines.

The fact that a Waldorf school is atop this list shows the problem is very much bipartisan, though the main anti-vax legislators these days are all Republicans. I’ve repeated this a million times, but the only way to improve things is to throw those anti-vax legislators out of office. Next year is a great opportunity to do that as three of them – Jonathan Stickland, Bill Zedler, and Matt Krause – all had close elections in 2018. The rest is up to us. Now go read the rest of the story for the history of how we got to this point.

Our measles risk

Do I spend too much time worrying about stuff like this, or do I not spend enough time on it?

Harris County is one of the nation’s most vulnerable counties to a measles outbreak, according to a new study based on international travel and the prevalence of non-medical vaccine exemptions.

The study, published Thursday in the journal Lancet Infectious Diseases, ranks Harris County as the county 9th most at risk of having clusters of people contract measles, the highly contagious, potentially fatal virus that has re-emerged as a public health threat after having been largely eradicated at the turn of the century. Tarrant and Travis counties also are at high risk of an outbreak, according to the study.

“Texas’ showing is on par with the other 16 states that allow vaccine exemptions for conscientious or personal reasons,” said Sahotra Sarkar, a University of Texas Austin professor and the study’s lead author. “You can expect the state, like other parts of the nation, to see more cases.”

Sarkar said Harris County’s vulnerability is mostly the result of its considerable international travel. The county’s number of non-medical vaccine exemptions was not among the state’s highest in a Texas health department report released earlier this week.

[…]

The new study was conducted by Sarkar and a Johns Hopkins University researcher using risk assessment models similar to one they used to correctly predict that Zika, the mosquito-born virus that can cause serious birth defects, would first affect Texas and Florida after it began spreading from the Southern Hemisphere midway through this decade. It also correctly predicted areas already experiencing measles outbreaks, such as Washington, Oregon and New York.

The authors didn’t consider the locations of measles cases already recorded. Instead, they looked at non-medical vaccine exemptions, international air travel and the incidence of measles in countries from which people came to the United States, particularly India, China, Mexico, Japan, Ukraine, Philippines and Thailand. In all, some 112,000 people have been diagnosed with measles outside the U.S. this year, according to the World Health Organization.

Peter Hotez, a Baylor College of Medicine professor of infectious disease and vaccine advocate, called the new study an advance over research he published last year that identified “15 hotspots” of vaccine exemptions among a subset of states. Harris County ranked seventh on that list.

“I think this is a nice refinement on our first attempt,” said Hotez. “It confirms the high risk of Texas counties to measles, something that we’ll need to consider seriously when planning for epidemics.”

It’s not clear what if anything can be done to mitigate this particular risk, so I’m back to wondering how much I should worry about it. Keep working to close the gap in vaccination rates, I guess. It annoys the crap out of me that we have to worry about this sort of thing in 2019, but here we are.

Can we turn the anti-vax tide in the Lege this session?

It sure would be nice, and this needs to be the primary goal.

In Texas, children are required to have certain sets of vaccinations before they can be enrolled in public school – including the vaccine for measles.

But parents who have “reasons of conscience” for not wanting their children to be vaccinated are allowed to opt out of vaccinations, a practice that experts say is forming a dangerous trend that helped fuel the most recent measles outbreak.

Statewide, there was only one confirmed case of measles in each of 2016 and 2017. In 2018, there were nine confirmed cases of measles, authorities say.

There are seven confirmed cases so far in 2019.

The legislature does not define what constitutes a “reason of conscience,” meaning that any parent, for any reason, can decide not to immunize their children against dangerous and sometimes deadly diseases.

Close to 57,000 children in Texas went to public schools unvaccinated in 2018 for non-medical reasons, according to Allison Winnike, president and CEO of The Immunization Partnership. She said those numbers are growing year-over-year since the non-medical, “reasons of conscience” exemption went into effect almost two decades ago.

Concerns about the rise in measles cases is the fulcrum for this. Anti-vaxxers had a good session in 2017, but their advantage is more partisan than non-partisan, and a couple of their leading advocates – Reps. Bill Zedler and Jonathan Stickland – both had close wins in 2018 and will be big targets in 2020, along with others in Tarrant County.

All this is good, but so far the only vaccine-related bill I could find of any value was SB 329 by Sen. Kel Seliger would require a biennial report on any outbreaks of vaccine-preventable diseases and the number of children without vaccines under the “reasons of conscience” law, but it doesn’t change the “reasons of conscience” law itself. That’s where we need to go, and we may as well get started on it this session. And we’d better not wait, because the anti-vaxxers are actively trying to make things worse.

A bill filed in the Texas Legislature this month by Representative Matt Krause, a member of the far-right House Freedom Caucus, would make it easier for parents to request vaccine exemptions. A similar version was left pending after a House Public Health Committee hearing in 2017, but Krause’s new bill would go further, explicitly preventing the state health department from tracking the number of exemptions. Even though the exemption data doesn’t include anything that could identify individual students and is only available at the school district level, Krause and Zedler point to fears among anti-vaxxers that they will be tracked and bullied. “We’ve seen instances in California, stuff like that, where they start hunting people down,” [anti-vax Rep. Bill] Zedler said.

Public health officials say the proposal would curb their ability to identify and stop disease outbreaks, and parents of immunocompromised kids would have even less information to decide where to send their children to school.

“This is the modus operandi for anti-vaxxers in Texas: to promote exemptions, obfuscate and minimize transparency,” said Peter Hotez, a leading vaccine scientist and dean for the National School for Tropical Medicine at Baylor Medical School. “To do this in the middle of a measles outbreak in Texas is especially unconscionable.”

[…]

Krause, who is also backed by Texans for Vaccine Choice, argues that his legislation merely streamlines the process for parents who will obtain the exemptions anyway. He dismissed the many concerns raised by medical professionals last session. “They did a very good job of painting the worst-case scenario,” Krause told the Observer. “I’m not so sure those fears are founded.”

Krause acknowledged that he has already fielded concerns about his bill, in particular the clause preventing the state from tracking vaccine exemptions. He said he would be willing to scrap that language “if Texans for Vaccine Choice or some other vaccine choice groups or other folks from the medical community say that’s a bad idea.” Texans for Vaccine Choice did not respond to a request for comment.

Rep. Krause’s bill is HB1490. He won by eight points in 2018, so be sure to find a good opponent for him too. As I’ve said many times before, the anti-vaxxers are better organized and far more vocal – Rep. Gene Wu notes his recent encounter with this bunch – but I continue to believe they’re a small minority. This needs to be an issue people lose election over, because the stakes are getting higher. Vox, Mother Jones, and Daily Kos have more.

Measles comes back to Houston

We all vaccinated our kids, right?

Five cases of measles have been confirmed in the greater Houston area, a regional cluster that makes Texas the eleventh state this year to report the highly contagious disease until recently thought virtually eliminated in the U.S.

The cases, all announced Monday, include three in Harris County, one in Galveston County and one in Montgomery County. They involve four children, all under 2 years of age, and a woman between the ages of 25 and 35. All are doing well now.

“This is a reminder for people to be on guard and be up to date on their vaccinations,” said Dr. Umair A. Shah, executive director for Harris County Public Health. “Measles, a serious disease, is in our community.”

Measles, caused by an airborne virus, is particularly dangerous, capable of causing serious neurological disorders and death in infants and the developing fetus in pregnant women. It is spread through direct contact with discharge through the nose and mouth as well as coughing and sneezing.

Shah said it was too early to say whether the five cases might be the start of a local outbreak. The counties are monitoring anyone exposed to the measles patients while they were contagious to see if they develop symptoms. None has so far.

Dr. Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital, said he’s concerned because in the pre-vaccine era, measles typically peaked in the late winner and early spring. He said “a perfect storm could be coming.”

[…]

It was unclear Monday if a lack of vaccination played a role in any of the Houston-area cases. All four children had received the first of the two shots — the second is given between the ages of 4 and 6 — and the woman said she’d been vaccinated, though the county is still working to confirm that through records.

Shah noted that the first dose of the MMR (measles, mumps and rubella) vaccine is fully protective in 85 percent of those who get it, but there’s no way of knowing if a child is in that group or the 15 percent who need the second shot to receive full protection.

Shah also noted that the person or persons who originally transmitted the virus may have been unvaccinated, he said.

The good news is that this outbreak is limited. This story said that Houston’s vaccination rate is above the national average, while this other story says just the opposite; I’m not sure what to make of that. It’s still a lot of cases at one time, and we’re already close to the nine cases total in Houston from last year. It could be worse, as the people in the greater Portland area can attest, but there’s no reason at all why it should be. You can listen to a short but timely interview with Dr. Hotez about the resurgence of measles here, and Texas Monthly has more.

Ebola treatment progress

This is encouraging.

Texas scientists who developed an effective vaccine for the deadly Ebola virus are now reporting promising results with new medication to better treat full-blown cases of the disease.

In a laboratory study published this week, researchers at the University of Texas Medical Branch at Galveston showed a single injection of two antibodies successfully treated monkeys infected with all strains of the virus, a significant advance on current treatment options which only cover one strain and require multiple injections.

“This medication would give doctors an advantage in situations where we don’t know which strain of Ebola is going to pop up next,” said Thomas Geisbert, a UTMB professor of microbiology and immunology and the study’s primary investigator. “The fear now, with all our eggs in one basket, is we’ll get burned with the outbreak of a strain there’s no protection against.”

Geisbert said the study results, published Wednesday in Cell Host & Microbe, suggest the medication would be effective even if Ebola viruses evolve over time, and Larry Zeitlin, president of Mapp Biopharmaceutical Inc., the drug manufacturer, said it should “reduce the burden on health-care workers in the field during outbreaks.”

[…]

New medications are increasingly being used in the Congo to treat Ebola, most notably ZMapp, which was initially deployed late in the first outbreak. But those medications work only against the Zaire strain and require multiple injections, a challenge in Third World settings. ZMapp, for instance, must be given three times, each a few days apart, and by infusion which takes up to five hours. The single infusion of MBP134 only takes minutes.

“That’s a huge advantage in chaotic outbreaks or reactive settings where it’s often difficult to track down and identify patients to give them a second dose,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital.

Hotez added that “of course, all of this needs to be confirmed in human clinical trials.” He said the current outbreak in the Congo “looks like a good time for such an evaluation.”

See here and here for some background. I don’t have anything to add here, I just thought we could all use a bit of positive news.

Where the anti-vaxxers are

A lot of them are right here.

Four Texas cities, including Houston, rank among the 15 metropolitan “hotspots” of vaccine exemptions, more than any other state, according to a new study.

The study found Austin, Fort Worth and Plano also are among the nation’s cities with the highest number of kindergartners not getting vaccinated for non-medical reasons. Since 2009, the proportion of children opting out of such recommended vaccines increased in Texas and 11 other states, the study showed.

“There are some scary trends we were able to identify,” said Dr. Peter Hotez, a Houston vaccine scientist and one of the study authors. “They’re a sign that anti-vaccine groups, such as Texans for Vaccine Choice, have been very successful at lobbying efforts – both of the Texas legislature and through social media and other advocacy — to convince parents not to vaccinate their kids.”

[…]

The overall number of people invoking non-medical exemptions isn’t yet high enough to threaten herd immunity, the idea that vaccination of most of the population provides protection for those individuals without immunity to a contagious disease. But public health officials fear clusters of “anti-vaxxers” could leave some children vulnerable.

Texas’ increasing exemptions have been well documented. Though the number is still small, they have spiked from less than 3,000 in 2003 to more than 45,000 of the state’s roughly 5.5 million schoolchildren today, a 19-fold increase.

Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital said he undertook the study because of the Texas increase. He said wanted to look at whether it was a phenomenon unique to the state or mirrored elsewhere. National vaccination rates haven’t changed much in recent years.

You can see the study here. Dr. Hotez is correct to identify the political problem as being a key aspect to this. One clear pathway to getting more kids vaccinated is to take away or at least tighten up the so-called “conscience” objections to vaccines. If the law says you have to vaccinate your kids, the odds are pretty good that you will. But first you have to pass such a law, and right now we have a legislature that’s not inclined to do that.

Still talking vaccines and measles

Because it keeps needing to be talked about.

Earlier this month, Dr. Peter J. Hotez, a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, detailed a disturbing prediction for 2017 in an op-ed for the New York Times: the country could be facing a measles outbreak, and the Lone Star State could among the earliest casualties. “Texas, where I live and work,” Hotez wrote, “may be the first state to once again experience serious measles outbreaks.”

[…]

The spread of measles—one of the most contagious and deadliest diseases—could be stopped by the Eighty-fifth Texas Legislature, where there are currently pending bills that take aim at correcting the anti-vaccination trend. In December, State Representative Donna Howard, a Democrat representing Austin, filed a bill that would require parents and students who choose not to be vaccinated to indicate that they will “opt-out,” as opposed to the current system in which people must “opt-in” in order to be vaccinated. The bill would also require education for parents and students before they choose to opt-out. A similar bill filed by Representative Sarah Davis, a Republican from Houston, would require parents to complete an online educational course to inform them about the dangers of opting out of vaccination.

But anti-vaxxers make up a strong political bloc, and they’ve successfully thwarted pro-vaccination efforts in the Lege before. In 2015, state Representative Jason Villalba of Dallas tried to pass a law that would have entirely removed the exemption protection for parents who claimed to have a “conscientious objection” to vaccinations. His proposal was promptly torn to pieces by a few thousand members of a Facebook group for Texas anti-vaxxers, which formed a PAC, Texans for Vaccine Choice, that ultimately killed Villalba’s bill.  “These people, they literally said it to my face—they hate me,” Villalba told the Texas Tribune in April 2016, after his bill flopped. “This is a group that is very dedicated, very organized; this issue is very important to them.” Even after the bill failed, the PAC kept on Villalba. Jackie Schlegel, the PAC’s creator, told KUT in January that PAC members “knocked on nearly 10,000 doors for his challenger.” Villalba narrowly avoided defeat. Villalba told KUT that he supports Representative Davis’s bill, but it seems unlikely he’ll try to revive his own. “I’m not interested in a suicide mission on this issue,” Villalba told the Tribune last April.

Texas remains one of only seventeen states that allow parents to exempt their children from receiving vaccinations due to philosophical objections. None of the currently pending bills in the Lege would change that. Still, the Texans for Vaccine Choice PAC has already started to push back against the pro-vaccine billse. The anti-vax crowd is active on social media, and let Davis know that they were upset about her bill. In several exchanges with these folks on Twitter in late January, Davis shot down claims that vaccines cause autism by calling such assertions “alternative facts.

See here and here for some background, then go read Rep. Davis’ Twitter battle with the anti-vaxxers. I’ve never been a big fan of hers, but my respect for her is higher than ever after seeing that. Despite the fact that the anti-vaxxers have a friend in the White House, I do believe we can get one or both of Rep. Davis and Rep. Howard’s bills passed. The anti-vaxxers are as we know an organized and vocal minority, but in the end they are still a minority. We do have them outnumbered, and we need to remember that. If you’ve gotten yourself in the habit of calling your legislators about this and that these days, please add these two bills to your list of things you ask them to support.

Trump and the anti-vaxxers

In case you needed another reason to dislike Donald Trump.

President Trump’s embrace of discredited theories linking vaccines to autism has energized the anti-vaccine movement. Once fringe, the movement is becoming more popular, raising doubts about basic childhood health care among politically and geographically diverse groups.

Public health experts warn that this growing movement is threatening one of the most successful medical innovations of modern times. Globally, vaccines prevent the deaths of about 2.5 million children every year, but deadly diseases such as measles and whooping cough still circulate in populations where enough people are unvaccinated.

Here in San Antonio, 80 miles southwest of the state capital, Texans for Vaccine Choice convened a happy hour to encourage attendees to get more involved politically. The event was among dozens of outreach events the group has hosted across the state. The relatively new group has boosted its profile, aided by a savvy social-media strategy, and now leads a contentious fight over vaccines that is gearing up in the current legislative session.

The battle comes at a time when increasing numbers of Texas parents are choosing not to immunize their children because of “personal beliefs.” Measles was eliminated in the United States more than 15 years ago, but the highly contagious disease has made a return in recent years, including in Texas, in part because of parents refusing to vaccinate their children. A 2013 outbreak in Texas infected 21 people, many of them unvaccinated children.

The modern anti-vaccine movement is based on a fraud. A study published almost 20 years ago purported to show a link between childhood vaccines and autism. The data was later found to be falsified, and the study was retracted.

[…]

Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, predicts that 2017 could be the year the anti-vaccination movement gains ascendancy in the United States. Texas could lead the way, he said, because some public schools are dangerously close to the threshold at which measles outbreaks can be expected. A third of students at some private schools are unvaccinated.

“We’re losing the battle,” Hotez said.

Although the anti-vaccine movement has been strong in other states, including California, Oregon, Washington and Colorado, experts say the effort in Texas is among the most organized and politically active.

“It’s a great example of an issue that has a targeted, small minority but an intense minority who are willing to mobilize and engage in direct action,” said Mark Jones, a political science professor at Rice University in Houston.

We’ve discussed this plenty of times before, and as you know I agree with Mark Jones. There’s no reasoning with these people. There’s only organizing, and making it so that being anti-vaccination – and let’s be clear, that’s what allowing broad parental-choice exemptions for vaccinating children is – is a disqualifier for public office. Either we vote these enablers out, or we suffer the consequences.

The coming measles outbreak

I hope we’re wrong about this.

Peter Hotez used to worry mostly about vaccines for children in far-away places. An infectious diseases researcher at Baylor College of Medicine in Houston, Texas, Hotez is developing shots against diseases in poorer countries such as hookworm and schistosomiasis.

But now, Hotez is anxious about children much closer to home. The number of schoolchildren not vaccinated against childhood diseases in Texas is growing rapidly, which means that the state may see its first measles outbreaks in the winter or spring of 2018, Hotez predicted in a recent article in PLOS Medicine. Disgraced antivaccine physician Andrew Wakefield has set up shop in the Texan capital, Austin, and a political action committee (PAC) is putting pressure on legislators facing a slew of vaccine-related bills.

“Texas is now the center of the antivaxxer movement,” Hotez says. “There is a big fight coming,” adds Anna Dragsbaek of The Immunization Partnership, a nonprofit organization in Houston that advocates for vaccinations.

Texas still has one of the highest vaccination rates for childhood diseases overall, 97.4%, according to the U.S. Centers for Disease Control and Prevention. But the number of children not vaccinated because of their parents’ “personal beliefs”—as opposed to medical reasons—has risen from 2300 in 2003, when such exemptions were introduced, to more than 44,000 so far this year, according to numbers prepared by The Immunization Partnership based on Texas Department of State Health Services data. The actual number may be much higher because an estimated 300,000 Texan children are schooled at home, says Susan Wootton, an infectious disease pediatrician at the University of Texas in Houston; though the law requires these kids to be immunized too, parents don’t need to submit proof of vaccination.

Measles is an extremely contagious pathogen and often the first one to spread when vaccination rates dip below about 95%. The risk of outbreaks is even greater because unvaccinated children aren’t randomly distributed. In Gaines county in western Texas, for instance, the exemption rate is already 4.8%, and at one school in Austin, it’s 40%. “I would describe Texas as sitting on a ticking time bomb,” Wootton says.

[…]

Meanwhile, a PAC named Texans for Vaccine Choice has sprung up after state Representative Jason Villalba, a Republican lawyer from Dallas, proposed scrapping nonmedical exemptions last year. (The Texas House of Representatives voted down the bill.) “While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Dragsbaek says. “They made Villalba’s primary campaign very, very difficult.” Rebecca Hardy, director of state policies at Texans for Vaccine Choice, says the group is not trying to convince parents that vaccines are dangerous, but fighting for their right not to immunize their children. (It’s also helping them apply for exemptions.)

Though almost all U.S. states allow religious exemptions from vaccination, only 18 permit exemptions based on personal beliefs; with 27 million residents, Texas is the most populous one. Another hotbed of resistance to vaccines, California, stopped allowing “philosophical exemptions”—which covered religious and personal beliefs—this year, after a measles outbreak that sickened more than a hundred people. The change in legislation led some Californians opposing vaccines to move to Texas, Hotez says.

The Texas legislature is now pondering several bills that would help shore up vaccination. One would make it compulsory for parents to complete an online course before refusing vaccination; another would require them to discuss their decision with a doctor. The bill with the best chances may be one that would allow parents to know the immunization rates at their child’s school. “This does not infringe on anyone’s right to have an exemption, it simply allows parents who need to protect their children to have adequate information to do so,” Dragsbaek says. But Hardy says her PAC is opposed to even this bill: “If it’s truly about a parent’s right to know the health status of a campus, then why are we not proposing bills that would give the rates of HIV-positive kids on campus, or hepatitis B-positive kids?” she asks.

The problem, as I’ve noted before, is that the anti-vax forces are vocal and organized, which gives them a disproportionate amount of influence in the Lege. If you’re still mad about the November election (and you should be!) and you’re looking to Do Something to make our state a better place, organizing in favor of pro-vaccination candidates and officeholders, in all levels of government, would be a good way to channel that energy. Note this does not have to be strictly partisan – Rep. Villalba, who drew the wrath of the anti-vaxxers in 2015, is a Republican. But until there’s a countervailing force against the likes of Texans for Vaccine Choice, they’re going to gain all the ground. You can’t fight something with nothing, and the pro-vaccine forces have nothing right now.