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Texas Department of State Health Services

Our COVID numbers are staying down

Let’s keep this going.

While the East Coast struggles with a fourth wave of rising COVID-19 infections, Texas experts say the state is doing “reasonably well” as case rates stabilize across the state.

Case rates and hospitalizations have plateaued in the region in recent weeks, averaging roughly 3,500 new daily reported cases, the lowest it’s been since early-to-mid September. The decline in hospitalizations has been an even more welcome trend, with fewer than 3,000 patients hospitalized for COVID, the lowest it’s been since June.

Medical experts such as Dr. Carl Vartian, an infectious disease specialist and chief medical officer at HCA Houston Healthcare Clear Lake and Mainland hospitals, suspect the winter freeze, increasing vaccination rates and the prevalence of antibodies in Texas’ population have kept case rates low over the last month.

[…]

“Texas is doing better than most states, which are seeing a pretty sharp rise in the number of daily new cases,” said Ben Neuman, a virologist at Texas A&M University.

The lower rate of infections doesn’t mean that Texans can let their guard down, though. Fewer than 37 percent of state residents have received at least one dose of the COVID-19 vaccine, and just over 20 percent have been fully vaccinated.

“You have to plateau before you rise, and I think that’s where we’re headed,” Neuman said.

The flat line of case rates starts with a sharp drop-off in testing. According to data from the Department of State Health Services, results from PCR testing dropped sharply during the winter freeze in February, and have not rebounded. As of April, Texas is testing at just half the rate it was before the state iced over.

While the number of daily tests has declined heavily, so too has the positive test rate. It’s now under 5 percent, and the second-lowest it’s been since the start of the pandemic, according to state data. Even with the reduced number of tests being conducted, fewer people are testing positive for COVID.

The low number of tests mean there could be a lag before a potential surge, Neuman said.

In Houston, medical experts are cautiously optimistic there won’t be a rise.

Usually, case rates spike first, followed by hospitalizations the week after and ventilator demand and deaths after that. So far, all three have stayed low in Houston, Vartian said.

The freeze was basically a one-week lockdown in the middle of February, and that no doubt helped keep infections down. I don’t know what it’s like anywhere else, but at least in my little part of the world people are still masking up, despite the Governor’s order. I won’t extrapolate from such a limited data point, but I feel hopeful that at least in the big cities people are still inclined to be cautious.

And I take heart at the progress in getting shots into arms. The Astros are getting their shots. The Rockets are getting their shots. Judge Hidalgo has gotten her first shot. People are celebrating the ways that their lives have been improved by getting vaccinated. (Can confirm, by the way.) I’m hopeful. We still have to be careful, but I can see the road ahead, and it’s going someplace good.

Chron analysis puts freeze death total at 194

Sobering, to say the least.

The deaths of nearly 200 people are linked to February’s cold snap and blackouts, a Houston Chronicle analysis reveals, making the natural disaster one of the worst in Texas this past century.

The tally, which is nearly double the state’s official count, comes from an investigation of reports from medical examiners, justices of the peace and Department of State Health Services, as well as lawsuits and news stories.

The state count, which is preliminary, has yet to incorporate some deaths already flagged by medical examiners as storm-related.

The 194 deaths identified by the Chronicle so far include at least 100 cases of hypothermia that killed people in their homes or while exposed to the elements, at least 16 carbon monoxide poisonings of residents who used dangerous methods for heat and at least 22 Texans who died when medical devices failed without power or who were unable to seek live-saving care because of the weather.

Sixteen deaths were from other causes, such as fires or vehicle wrecks, while the remaining 40 were attributed by authorities to the storm without listing a specific cause.

“This is almost double the death toll from Hurricane Harvey,” said State Rep. Rafael Anchia, D-Dallas. “There was no live footage of flooded homes, or roofs being blown off, or tidal surges, but this was more deadly and devastating than anything we’ve experienced in modern state history.”

The toll is almost certain to grow in coming weeks as death investigators in the state’s most populous counties clear a backlog in cases from the cold snap. The Travis County medical examiner alone is investigating more than 80 deaths between Feb. 13 and Feb. 20.

The deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.

The previous count released by the state was 111, but as noted then and in this story that is sure to go up. There’s no central database for this kind of thing, only 14 counties have a medical examiner’s office, and not all county data is currently available. As with COVID deaths, there are likely some cases where one could argue whether the freeze was the actual cause of death or whether it was just proximate. The main point here is that the freeze was responsible for a lot of misery around the state and by any count more deaths than there were from Hurricane Harvey. It remains to be seen if the Legislature and the Public Utility Commission (which currently has no members) are taking adequate action to prevent this from ever happening again.

Winter storm death count now at 111

A revision of the numbers. Expect this to happen at least once more.

At least 111 Texans died as a result of last month’s winter storm, according to updated numbers released Thursday by the state Department of State Health Services.

The newly revised number is nearly twice what the department had estimated last week, and will likely continue to grow. Some of Texas’ larger counties, such as Tarrant County, have yet to report any storm-related deaths.

The majority of people died from hypothermia, but health officials also attributed deaths to “motor vehicle accidents, carbon monoxide poisoning, medical equipment failure, exacerbation of chronic illness, lack of home oxygen, falls and fire.”

[…]

Harris County reported 31 storm-related deaths, the largest share in the state. Travis County followed with nine deaths.

Health officials will continue to update their preliminary findings weekly.

According to DSHS, the data is compiled from forms that certify deaths are related to a disaster, notification from death certifiers and analyses of death certificates from state epidemiologists.

See here for the background. As a reminder, there were 103 deaths attributed to Hurricane Harvey, so the February freeze event (I’m sorry, I’ve not adopted the new paradigm of naming winter storms, so I have not and probably will not again refer to this as “Winter Storm Uri”) has now surpassed that total. And will likely put some more distance between them when the next month’s data is available.

There has been a bit of legislative action on this front.

A bill that would overhaul Texas’ energy industry — including mandating weatherization for natural gas and power generators — was approved by a Texas Senate committee on Thursday.

The sweeping Senate Bill 3, sponsored by Republican state Sen. Charles Schwertner of Georgetown, includes a number of reforms that have been floating around the state Capitol since last month’s deadly winter storm left millions without electricity during freezing temperatures. While the Texas House earlier this month approved a package of similar, standalone bills, Thursday’s vote represents the first substantive action on the issue by the upper chamber.

“This is an important issue to get right for the people of Texas, for the future of Texas, for the economy of Texas,” Schwertner said.

Chief among the bill’s provisions is a requirement that all power generators, transmission lines, natural gas facilities and pipelines make upgrades for extreme weather conditions — a process known as weatherization. Many power generators and gas companies were ill-suited for the freezing temperatures in February, which led gas pipelines to freeze and power transmission to falter.

The measure would delegate rulemaking authority to the Texas Railroad Commission, which regulates the oil and gas industries, and the Texas Public Utility Commission, which regulates the electric and telecommunication industries. If a gas or energy company fails to comply with the weatherization rules, it would face a fine up to $1 million for each offense. The bill does not address funding to pay for the required upgrades.

A Texas House committee earlier this month passed a similar weatherization bill. But the requirements only apply to electric companies, not natural gas companies. In public testimony before the Legislature, Railroad Commission Chair Christi Craddick largely dodged talks of winterizing the natural gas supply chain.

There’s more, so read the rest. I don’t know enough to offer a general critique of these bills, but I would certainly argue that natural gas companies should have the same weatherization requirements. All of these bills are sure to change as they move from one chamber to the other, so we’ll need to see where they wind up.

The vaccination eligibility list is about to be wide open

Go ahead and get on it, though be prepared to wait as the supply issues work themselves out.

Everyone age 16 and older, regardless of occupation or health status, will be eligible for the COVID-19 vaccine in Texas starting March 29, state health officials said Tuesday.

The Texas Department of State Health Services is still asking providers to prioritize appointments for people who are 80 and older, and to prioritize walk-ins from anyone in that age group who shows up without an appointment. The vaccines are not limited to Texas residents, and citizenship is not a requirement for the vaccine.

“We are closing in on 10 million doses administered in Texas, and we want to keep up the momentum as the vaccine supply increases,” said Imelda Garcia, DSHS associate commissioner for laboratory and infectious disease services and the chair of the state’s Expert Vaccine Allocation Panel.

Until now, eligibility for the vaccine was mainly restricted to a few groups: health care workers, people ages 50 and older, those with certain underlying health conditions who are 16 or older, and employees of schools and day care centers. Texas began receiving vaccines in mid-December.

The vaccine is still in short supply as the announcement makes about 22 million people eligible on Monday. The state has been allocated more than 14 million doses since distribution began in December — far short of the supply needed to fully vaccinate everyone right away.

[…]

The state is also launching a website next week for people to sign up for vaccines at public health centers and state-run clinics. The Texas Public Health Vaccine Scheduler will alert participants to upcoming events and available appointments. For those who do not have access to the internet, the state will also be creating a hotline for appointments by phone, officials said.

The DSHS has more on Twitter. Great news for those who have not yet been eligible, though as we have previously discussed it’s not necessarily great for the distribution effort or for vaccine equity. All states were mandated by President Biden to make the vaccine generally available by May 1, so this is just getting a one-month head start on that.

County Judge Lina Hidalgo calls this a milestone moment.

“Opening vaccine eligibility vaccines to every adult is a key milestone in our fight against COVID-19,” Hidalgo said. “The onus is now on each adult to do their part. This vaccine is safe and effective, and the faster we all get a vaccine the sooner we’ll be able to pull through this crisis, get our economy running at full speed, and get life back to normal.”

Many experts have continued to raise concerns about unequal access to vaccines, particularly among low-income communities.

Rice University health economist Vivian Ho said the opened eligibility could help on that front because public health agencies will be able to, for example, vaccinate all workers at a grocery store.

“Now you can say we are going to go to workplaces, because there’s no age limit,” she said.

Conversely, Ho said, the announcement will do little to convince people who have already decided not to get vaccines, namely in communities outside of major cities.

Opening eligibility criteria will clear confusion for many communities who have hesitated to get a COVID-19 vaccine because of constantly changing age and medical condition restrictions, said Luis Torres-Hostos, dean of the University of Texas – Rio Grande Valley School of Social Work.

Torres-Hostos, who has worked with his university to get the message out to Latino communities, is hopeful public health officials will have more luck with immunization with these changes.

“Where are the vaccine deserts? Where are the places where it’s really hard for members of the community to get their vaccine?” he said. “We’ve got to do something to make sure that the vaccine is being given there.”

However, even his optimism comes with a caveat. Expanded criteria will only fix inequities if it comes with increased vaccine supply.

Communities of color and low-income communities are not hesitant to get the vaccine; a recent poll by the Kaiser Family Foundation finds 7 in 10 Hispanic people surveyed have received or want to book an appointment for a COVID-19 vaccine.

“If we build it, they will come,” Torres-Hostos said.

I sure hope this will help with the inequity issue, and I agree it will clear up any lingering confusion. We’ll look for that DSHS website when it’s up (and hopefully doesn’t crash). Y’all get yourself – and anyone you know who might need some assistance – in line for the vaccine.

Winter storm death count at 57

This is likely to rise as we get better data.

At least 57 people died in Texas as a result of last month’s winter storm, according to preliminary data the state health department released Monday.

The largest number of deaths — at least 25 — occured in Harris County, the Texas Department of State Health Services reported.

The deaths occurred in at least 25 counties between Feb. 11 and March 5, the state agency said. The majority of verified deaths were associated with hypothermia, but health officials said some were also caused by motor vehicle wrecks, “carbon monoxide poisoning, medical equipment failure, falls, and fire.”

The preliminary data is “subject to change” as state disaster epidemiologists gather additional information and additional deaths are verified, the agency said. The information will be updated weekly, it said.

For purposes of comparison, there were 103 deaths in Texas attributed to Hurricane Harvey, 68 to direct effects of the storm and 35 more in the aftereffects. The financial costs of the freeze were higher. Just keep all that in mind when you see Greg Abbott and Dan Patrick and others play the blame game.

Vaccine progress

Good news.

Texas will surpass more than 7 million COVID-19 vaccination doses administered today, top public health officials told the Texas Senate as Gov. Greg Abbott lifted all capacity limits for businesses and ended government-imposed mask mandates in the state.

At the same time, the health officials also offered a strong defense of the previous mask mandates, saying they reduced the chance of asymptomatic people spreading the virus and resulted in a record low year for influenza in Texas.

The speed with which vaccinations are being distributed is one of the keys to Abbott’s new order removing all mask mandates and allowing all businesses to re-open to 100 percent of their occupancy. Still, Texas has one of the lowest vaccination rates in the country, with 15.8 percent of residents having received at least one shot.

“We have come a long way in a very short period of time,” said Imelda Garcia, a top official with the Department of State Health Services, as she testified before a committee in the Texas Senate on Wednesday morning.

Garcia reminded lawmakers that Texas didn’t get its first vaccine shipments until Dec. 14. She lauded vaccine providers around the state for stepping up to administer so many shots in such a small window.

“They have been busting their butts in order to get shots in arms as fast as they physically and possibly can,” Garcia said.

Harris County alone topped 1 million doses on Tuesday.

Because the majority of vaccines in Texas require two doses, the number of people fully vaccinated is just over 2 million statewide.

Yes, there has been a lot of great work done, and everyone involved should be praised and thanked for it. There have been plenty of obstacles to overcome, that’s for sure. Because I’m a numbers nerd, I feel like I have to say something about the totals and percentages cited in this story, because as is they’re making me twitch. Seven million people would represent about 23% of the total state population. Given that the vaccines are only being given to those 16 and up, that makes the denominator in that fraction smaller, and thus would make the percentage higher. The only way this works if that total of “seven million doses administered” counts all shots given, both first and second. That would put the number of people that have had at least one shot at almost five million, which is closer to that 15.8% (it’s now higher on that NYT page, as it updates in real time). I’m just a little annoyed that I had to think it through like this to make sense of it all.

Not so good news.

The Texas Medical Center, in partnership with the city, is now administering 232,000 COVID-19 vaccine doses per week, and experts expect that number to ramp up as more vaccines are shipped to the state.

While vaccination rates are increasing and COVID-19 cases are trending downward again, medical officials said the public shouldn’t get too comfortable. Texas Medical Center leaders said there is currently no strong correlation between vaccination and hospitalization rates.

Experts are anxious that there could be another surge as students go on spring break this month. There’s more virus in Houston, and it’s spreading faster as more infectious variants circulate in the area.

“We’re not seeing the rapid decline we want to see,” Bill McKeon, president of the Texas Medical Center, said at a Wednesday webinar on the state of COVID-19 in Houston.

Part of the reason for this is that it takes time for the vaccine to take full effect – this is true of both the one-shot J&J vaccine and the two-dose Pfizer and Moderna vaccines – and it is eminently possible to continue to carry the disease after getting your shots. You will be much less likely to get sick, but you can pass it on to others, who may not be so lucky. This is why everyone who cares about keeping people alive and healthy are continuing to urge everyone to wear masks and maintain social distancing. We are approaching a point where those things will not be vital, but we are not there yet.

Good news for some, just news for others.

Texans ages 50 and older will be eligible for the COVID-19 vaccine starting March 15, state health officials announced Wednesday.

“We’ve seen a remarkable decrease in the number of hospitalizations and deaths since people 65 and older started becoming fully vaccinated in January,” said Imelda Garcia, the chair of the state’s Expert Vaccine Allocation Panel. “Expanding to ages 50 to 64 will continue the state’s priorities of protecting those at the greatest risk of severe outcomes and preserving the state’s health care system.”

Currently, the state is vaccinating members of priority groups 1A and 1B, which include health care workers, Texans 65 and older, and anyone over age 15 who has a pre-existing condition. Last week, state officials also made educators and child care employees eligible for a dose.

Those 50 and older will be included in priority group 1C. More than 93 percent of Texans who have died from the virus have been at least 50 years old, health officials said in a press release.

One can certainly argue that some other folks should have been next in line, but this is where we are. On the plus side, thanks to President Biden, everyone will be eligible for the shot in a few weeks. Until then, get yourself signed up at your first opportunity. And keep that mask on until someone other than Greg Abbott tells you to take it off. The Trib has more.

Teachers can get the COVID vaccine now

About time.

Texas teachers are now eligible for COVID-19 vaccines, health officials announced Wednesday.

Effective immediately, all Texas vaccine providers should include all school staff, Head Start program staff, and child care staff in their vaccine administration programs, according to a notice the Texas Department of State Health services sent to providers.

The notice comes after the Biden administration Tuesday urged all states to prioritize vaccinating teachers and school staff. Texas had not previously prioritized teachers. Texas received a letter from the U.S. Department of Health and Human Services Tuesday night directing it to expand eligibility, according to a DSHS news release.

Those eligible are “those who work in pre-primary, primary, and secondary schools, as well as Head Start and Early Head Start programs (including teachers, staff, and bus drivers) and those who work as or for licensed child care providers, including center-based and family care providers,” according to the federal directive.

State health officials said earlier this week that they expected to finish vaccinating older and most vulnerable Texans in the next few weeks and broaden eligibility to include more Texans by the end of the month.

That new group was expected to include teachers before Wednesday’s announcement, but officials have not said who else would be in that new “1C” group.

[…]

Educators and advocates have been begging the state to include teachers as it rolled out its vaccination program this winter and spring. After Abbott’s announcement Tuesday, several educator groups chastised him for removing the mask requirement without prioritizing teachers for vaccines.

“Abbott has shirked his responsibility to stick with medical advice and clarify what needs to happen to keep our schools safe. Every top health official has stressed that even with vaccinations we need to keep using the most simple tools to stop the spread,” said Zeph Capo, president of the Texas American Federation of Teachers, in a statement Tuesday.

If you want schools to be open – and you should want schools to be open, if they can open safely – then you need to make sure that everyone who works at those schools can get vaccinated. It’s pretty simple. Naturally, this took a nudge from the federal government for it to happen.

Dr. John Hellerstedt, who serves as commissioner for the Department of State Health Services, told the the Texas House of Representatives’ Committee on Public Health moments before the release was published that the change came after President Joe Biden announced Tuesday that he will direct states to prioritize teachers and school-based staff for vaccines.

“Right now we’re planning in Texas to see how we will bring that to functioning operation,” he said. “We are actively engaged in that as a priority item.”

About 30 states currently allow teachers to get earlier access to vaccines than the general public, Biden said Tuesday. Biden added that he was “directing” the remaining states to follow suit — though he did not specify what power he planned to employ to force the change — and announced he would use a federal pharmacy program to deliver vaccines to school employees and childcare workers.

“Not every educator will be able to get their appointment in the first week, but our goal is to do everything we can to help every educator receive a shot this month, the month of March,” Biden said.

The federal directive defined the people now eligible as “those who work in pre-primary, primary, and secondary schools, as well as Head Start and Early Head Start programs (including teachers, staff, and bus drivers) and those who work as or for licensed child care providers, including center-based and family care providers.”

Good thing the vaccine supply is increasing. It would be nice if most school districts continued to require masks for everyone, so that the teachers who can’t get a vaccine in the next week or so still have some protection. The Press has more.

Abbott lifts statewide mask mandate

Unbelievable.

Gov. Greg Abbott announced Tuesday that he is ending Texas’ statewide mask mandate next week and will allow all businesses to operate at full capacity.

“It is now time to open Texas 100%,” Abbott said from a Mexican restaurant in Lubbock, arguing that Texas has fought the coronavirus pandemic to the point that “people and businesses don’t need the state telling them how to operate” any longer.

Abbott said he was rescinding “most of the earlier executive orders” he has issued over the past year to stem the spread of the virus. He said starting next Wednesday, “all businesses of any type are allowed to open 100%” and masks will no longer be required in public. The mask requirement has been in effect since last summer.

Meanwhile, the spread of the virus remains substantial across the state, with Texas averaging over 200 reported deaths a day over the last week. And while Abbott has voiced optimism that vaccinations will accelerate soon, less than 7% of Texans had been fully vaccinated as of this weekend.

Texas will become the most populous state in the country not to have a mask mandate. More than 30 states currently have one in place.

Abbott urged Texans to still exercise “personal vigilance” in navigating the pandemic. “It’s just that now state mandates are no longer needed,” he said.

Currently, most businesses are permitted to operate at 75% capacity unless their region is seeing a jump in COVID-19 hospitalizations. While he was allowing businesses to fully reopen, Abbott said that people still have the right to operate how they want and can “limit capacity or implement additional safety protocols.” Abbott’s executive order said there was nothing stopping businesses from requiring employees or customers to wear masks.

[…]

Texans have been under a statewide mask mandate since July of last year — and they have grown widely comfortable with it, according to polling. The latest survey from the University of Texas and Texas Tribune found that 88% of the state’s voters wear masks when they’re in close contact with people outside of their households. That group includes 98% of Democrats and 81% of Republicans.

The absence of statewide restrictions should not be a signal to Texans to stop wearing masks, social distancing, washing their hands or doing other things to keep the virus from spreading, said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 task force.

Carlo declined to react specifically to Abbott’s order, saying he had not had a chance to read it. He also expressed concern that new virus variants, specifically the U.K. variant, could still turn back the positive trends cited by Abbott.

“We’re facing unacceptably high rates, and we still hear every day about more and more people becoming sick. And it may be less than before, but it’s still too many,” Carlo said. “Even if businesses open up and even if we loosen restrictions, that does not mean we should stop what we’re doing because we’re not there yet.”

It was clear from what Abbott said during President Biden’s visit that he was planning to take action to loosen restrictions. I was prepared for him to announce a step-down or a schedule or something more gradual. I did not expect him to just rip the bandage right off. I don’t know what to say, but Judge Hidalgo does, so let’s listen to her.

Harris County Judge Lina Hidalgo and Mayor Sylvester Turner slammed Gov. Greg Abbott Tuesday for allowing all businesses in Texas to fully reopen next week and lifting his statewide mask mandate, suggesting the governor timed the move to distract angry Texans from the widespread power outages during the recent winter storm.

“At best, today’s decision is wishful thinking,” Hidalgo said. “At worst, it is a cynical attempt to distract Texans from the failures of state oversight of our power grid.”

Turner said Abbott’s decision to rescind the COVID measures marked “the third time the governor has stepped in when things were going in the right direction,” a reference to the surges in cases, hospitalizations and deaths that ensued after Abbott implemented reopening guidelines last year.

“It makes no sense,” Turner said. “Unless the governor is trying to deflect from what happened a little less than two weeks ago with the winter storm.”

[…]

Before Abbott’s announcement, Hidalgo and Turner sent the governor a letter urging him not to lift his statewide mask mandate.

“Supported by our public health professionals, we believe it would be premature and harmful to do anything to lose widespread adoption of this preventative measure,” Hidalgo and Turner wrote, arguing the mandate has allowed small businesses to remain open by keeping cases down.

The disparity between Hidalgo and Turner’s concerns — that Abbott would simply lift the mask order but keep other restrictions intact — and his decision to fully reopen the state puts on full display the diverging messages Houstonians are receiving from their local Democratic leaders and the Republicans who run the state. While Hidalgo is telling residents to stay home and buckle down, Abbott is giving the green light for a return to normal life, albeit one where Texans govern themselves using “personal responsibility,” he said Tuesday.

We know how well that’s worked so far. The irony is that other parts of state government still understand what’s at stake:

I’d love to say that Abbott will suffer political blowback for this, but polling data is mixed and inconsistent.

Texas voters’ concerns about the spread of coronavirus are higher now than they were in October, before a winter surge in caseloads and hospitalizations, according to the latest University of Texas/Texas Tribune Poll.

Almost half of Texas voters (49%) said that they are either extremely or very concerned about the spread of the pandemic in their communities — up from 40% in October. Their apprehension matches the spread of the coronavirus. As cases were rising in June, 47% had high levels of concern.

Caseloads were at a low point in October, as was voter concern about spread. And sharp increases through the holidays and into the new year were matched by a rise in public unease.

Voters’ concern about “you or someone you know” getting infected followed that pattern, too. In the current poll, 50% said they were extremely or very concerned, up from 44% in October, and close to the 48% who responded that way in the June poll.

“The second, bigger surge seems to have had an impact on people’s attitudes,” said James Henson, co-director of the poll and head of the Texas Politics Project at the University of Texas at Austin. “In October, there was a trend of Republicans being less concerned, but this does reflect what a hard period the state went through from October to February.”

While their personal concerns have risen, voters’ overall assessment of the pandemic hasn’t changed much. In the latest survey, 53% called it “a significant crisis,” while 32% called it “a serious problem but not a crisis.” In October, 53% called it significant and 29% called it serious.

Economic concerns during the pandemic remain high. Asked whether it’s more important to help control the spread of the coronavirus or to help the economy, 47% pointed to the coronavirus and 43% said it’s more important to help the economy. In a June poll, 53% of Texans wanted to control the spread and 38% wanted to focus on the economy.

“The economy/COVID number is 2-to-1 in other parts of the country. Here, it’s almost even,” said Daron Shaw, a UT-Austin government professor and co-director of the poll. “What was a 15-point spread is now a 4-point spread.

So people are concerned about the pandemic, but also about the economy. Some of that may just be a reflection of the partisan split, but I have no doubt that Abbott thinks the politics of this are good for him, and that’s even before we take into account the distraction from the freeze. The scenario where he’s most likely to take a hit is one in which the numbers spike and a lot more people die. Nobody wants that to happen, yet here we are at a higher risk of it because of Abbott’s actions. It’s just enraging. So please keep wearing your damn mask, even after you get your shots. Wait for someone with more credibility than Greg Abbott to tell you it’s safe to do otherwise.

One more thing:

We both know how plausible that is. Texas Monthly, Reform Austin, the San Antonio Report, the Texas Signal, and the Chron has more.

More vaccines coming

Bring ’em.

The Food and Drug Administration approved Johnson & Johnson’s COVID-19 vaccine on Saturday for use in the U.S., the third vaccine to be approved since the pandemic began.

Texas could initially receive more than 200,000 doses, according to the Texas Department of State Health Services, but the agency hasn’t received a timeline for when they would arrive. The company has said it plans to ship 20 million shots in the U.S. by the end of March and an additional 80 million doses before the end of June.

Texas received about 1.5 million vaccine doses by Pfizer and Moderna this week, including doses that had been undelivered earlier in the month because of the winter storm.

Unlike those vaccines, Johnson & Johnson’s formulation is the first to only require one dose, and it can be stored at regular refrigeration temperatures. The others require two doses, and Pfizer doses must be stored at below-freezing temperatures.

[…]

Five million vaccine doses have been administered overall in Texas as of Feb. 25. That equals about 5.8% of the state’s population — a long way from the 70% to 80% that experts estimate is necessary to achieve herd immunity. It would require nearly 100% of adults to be vaccinated to reach those figures, according to census numbers.

Scientists are still monitoring how well vaccines prevent the spread of the coronavirus, and health officials advise those who are vaccinated to continue wearing masks, social distance and follow other COVID-19 safety guidelines.

Hopefully, the J&J vaccine will really kick this up a notch, since it only requires the one shot. But as always, it’s first a matter of supply, and just having another supplier should help. If J&J is delivering 80 million doses nationally by the end of June, that should be six or seven million for Texas. It’s all about the numbers.

We can get back to vaccinations

Federal vaccination super site opening this week.

COVID-19 vaccination efforts are about to significantly ramp up next week in Houston.

The region’s first vaccination “super site” will open on Tuesday at NRG Stadium, Harris County Judge Lina Hidalgo announced on Twitter Friday afternoon.

The site will vaccinate 42,000 people per week for three weeks, Hidalgo said.

The site is one of three in Texas backed by the Federal Emergency Management Agency. The two other Texas super sites are located in Dallas-Fort Worth at AT&T Stadium and Fair Park, the Houston Chronicle reported.

The opening of the super site means Houstonians who signed up via the city or county’s vaccine waitlist should keep an eye out for updates on when they may be able to schedule an appointment. Residents who have yet to sign up for either waitlist are encouraged to do so.

See here for the background. COVID vaccinations pretty much came to a halt last week, which puts a bit of a crimp in the pace to get 100 million vaccinations administered in the first 100 days of the Biden administration, but they had been running ahead of pace and should be able to get back on track. Sure is nice to be able to type and read those words and nod along instead of scoffing, isn’t it?

We should be vaccinating grocery workers

The only disagreement I have with this is that we should have more broadly classified “essential workers” from the beginning, and it should include more people who do not have the ability to work from home.

Nearly a year into the pandemic, Ryan’s experience that day reflects the challenges that grocery store workers across Texas are facing in their stores every day. For months, workers have risked their health to keep shorthanded grocery stores open, all while dealing with increased hours and customers refusing to wear masks.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices urged states to include front-line essential workers in Phase 1B of vaccine allocation. But Texas decided not to include any essential employees like grocery store workers in the state’s current vaccine priority groups. Without any guarantee of vaccine prioritization, grocery workers now find themselves overwhelmed and continually exposed to the virus with no end in sight.

[…]

Back in April, when people made a rush for essential supplies like toilet paper and soap, Gov. Greg Abbott tweeted a message of support for grocery store workers, saying that “everyone across our state appreciates your hard work to help Texans respond to the #coronavirus.” Since then, workers say they have felt forgotten and abandoned by the state government.

In December, the Texas Expert Vaccine Allocation Panel, in charge of designating each population currently eligible to receive vaccinations, decided against including front-line essential workers in Phase 1B. The Department of State Health Services said that the panel wanted to reserve vaccine doses for those at the highest risk of death, which includes people over 65 and anyone over 16 with a chronic medical condition that puts them at higher risk.

At least 8 million Texans currently qualify for Phase 1A or 1B of vaccine allocation, but the state has received fewer than 4 million doses thus far. The panel is currently considering potential priority groups for Phase 1C of vaccine rollout, and its decision will depend on epidemiological data about virus transmission, according to DSHS Director of Media Relations Chris Van Deusen.

However, at least 11 states and the District of Columbia followed CDC recommendations by deciding to put front-line essential workers, including grocery store employees, in the their latest rounds of vaccine allocation, according to The Washington Post. New York allowed grocery workers to start getting the vaccine last month. Arkansas has also started vaccinating teachers and educators in the first round of essential workers to receive doses, and the state plans to expand distribution to other essential workers later this month.

“You feel like you don’t matter when your own state goes against every recommendation that there is out there,” said Dawn Hand, who works at a Kroger in Houston. “Why don’t we matter? What’s your answer to that?”

I personally feel that prioritizing people who had to do in-person work, as some states have done, was the better choice than making group 1B open to the over 65 crowd, and I say that even knowing quite a few people who have gotten their vaccine as a result of that choice. Big employers, like grocery stores and big-box retail – plus all of their delivery workers – could have been brought in to help distribute and administer the shots. This would target people who are clearly at risk, and as the story notes would also have helped with the equity problem. Another group of essential workers that should have been prioritized are meatpacking plant employees, who have not only been extremely hard-hit by COVID (due in large part to the inhumane practices of their employers) but are also lower-income, often non-English-speaking people who are harder to reach for the vaccine. In their case, I’d want to send clinicians to their locations, and use whatever threats and incentives are needed to make sure their bosses give them the time and space to get vaccinated. We could still do all of this in round 3, but I don’t blame any one of these folks for thinking that they were left behind.

Here come the super-sites

Cool.

Texas is working with the federal government to open vaccination “super sites” that could administer upward of 5,000 COVID-19 vaccines per day, Gov. Greg Abbott said Monday.

Houston and Dallas will likely host the initial two sites, Abbott said, with “possible expansion to other locations.” They would be open every day for eight weeks, offering as many as 672,000 shots between them.

The sites would be the largest to administer COVID-19 vaccines in Texas, which has lost more than 35,000 residents to the coronavirus. They come at the beginning of an increased federal presence in the state’s vaccine rollout, as President Joe Biden has promised to scale up vaccine distribution as quickly as possible.

In recent weeks, Texas officials have employed a similar strategy at the state level, designating about 80 vaccination “hubs” statewide that receive most of the weekly vaccine allotment. The largest hubs clock in just above 10,000 doses a week, though allocations vary by site.

Lauren Lefebvre, a spokeswoman for the Federal Emergency Management Agency, said officials are working with Texas on the specifics for the super sites, which weren’t solidified yet Monday. The agency is partnering with state governments across the nation to pilot up to 100 community vaccination centers primarily staffed by federal employees.

[…]

Harris County Judge Lina Hidalgo said the “super site” announcement was “good news” that would allow county officials to begin chipping away at a vaccination waitlist including roughly 300,000 residents — far exceeding available doses.

“The sooner we increase vaccine supply, the faster we can reach herd immunity,” she tweeted. “We’re ready to support state and Biden administration efforts to distribute more vaccines.”

See here for some background. According to the Trib, FEMA brings its own supply of the vaccine, which is separate from the weekly allotment the state gets from the CDC. That ought to help ease the supply burden a bit. Good news all around.

“Nobody is getting enough”

Pretty much says it all.

As Texans scramble for appointments for the COVID-19 vaccine, federal data helps explain why: Relative to its population, the Lone Star State ranks near the bottom in the country in number of doses received.

Texas has received the second-highest number of doses in the country. Per capita, however, Texas comes in closer to the bottom at 49th out of all 50 states, Washington, D.C., and Puerto Rico, according to an analysis of Centers for Disease Control and Prevention data. Federal officials say there is a good reason for that: Vaccine distribution is based on the adult population of each state. And roughly a quarter of Texans are under the age of 18. Still, even when adjusted for adults only, Texas ranks 48th.

As Texas politicians from Congress down to local county judges push for more doses, the supply remains scarce, even for people older than age 65 and those with serious medical conditions.

“Nobody is getting enough. That is plain and simple,” said Brazoria County Judge Matt Sebesta, estimating that more than half of the roughly 130 providers that signed up to distribute vaccines in the county have yet to receive any doses. “We are kind of where we were last April with personal protective equipment and testing equipment: not enough to go around.”

State health officials insisted they are ordering as many doses as they can from the federal government and distributing them as quickly as they can.

“The supply of vaccines is limited by both the manufacturers’ ability to produce it and the amount allotted to Texas by the federal government,” said Lara Anton, a spokeswoman for the Texas Department of State Health Services. “The federal government determines how much vaccine will be sent to providers in the state on a weekly basis.”

U.S. Department of Health and Human Services spokesman Bill Hall said the vaccines are distributed based on an algorithm that takes into account the adult population in each state and U.S. territory. “We are committed to fair and equitable allocation of vaccines and therapeutics,” Hall said.

Texas has received more than 3.5 million doses of the vaccine, though the rollout so far has been anything but smooth. County registration lines have crashed under demand.

We know the story by now. There’s more vaccine coming, and that supply will increase further over time, but the administration of those doses has been chaotic. Greg Abbott has done the hard work of taking credit for everyone else’s hard work, but he never did anything to push the Trump administration to have a plan – let alone make sure the state of Texas had one, given Trump’s plan was to make the states do it – and it’s hard to imagine him making a diplomatic call to the Biden administration to ask for more help. He has reassured us that everything is going great, though, so at least we have that.

More vaccines coming

Still not enough, but getting better.

Texas this week expects to receive more than half a million first doses of the COVID-19 vaccine from the federal government, state health officials announced Friday.

The 520,425 doses will be shipped to 344 providers, including 82 hubs, in 166 counties across the state, according to the Department of State Health Services.

Officials attributed the boost in available vaccine to a 30 percent increase in Moderna doses being sent to the state and a “one-time return” of 126,750 doses of the Pfizer vaccine that the state had been required set aside for a program that overestimated the number of needed doses.

Doses that had been set aside, for a long-term care facilities program, will specifically go to providers located in counties that have been allocated “significantly” fewer vaccines than their share of the population, including in the suburban Houston area, health officials said.

[…]

As of Friday, providers across the state had administered about 2.2 million doses, according to DSHS. More than 1.75 million people had received at least one dose while more than 410,000 people were considered fully vaccinated.

Reread that last paragraph, please. When you see “the state had administered about 2.2 million doses” of the COVID vaccine, do you think “2.2 million people have been vaccinated for COVID”? Because if you do, and I wouldn’t blame you if you do, what do you then think when you read “1.75 million people had received at least one dose while more than 410,000 people were considered fully vaccinated”? It’s a very different reality, isn’t it? That’s the magnitude of the problem here.

For what it’s worth, the 520K doses is almost exactly what would be needed to meet the 75K per day goal that Greg Abbott has set. (We’ll put aside the second-shot question for the moment.) Again, though, this puts us in range of getting everyone vaccinated in a little more than a year. We don’t have that kind of time. We need to be aiming for something like one million vaccinations per week, or close to 150K per day, to get this done in a timely fashion, and that’s still a duration of more than six months. Federal help is coming – in fact, it’s already here – and I expect to see our daily and weekly totals rise soon, but we really need to appreciate how massive the scope of this project is, and how far behind we already are thanks to the criminal incompetence and negligence of the previous administration and its enablers. Be very, very upset about this.

More vaccination hubs

Keep ’em coming.

State health officials Saturday announced 79 hub providers that are expected to receive allotments of COVID-19 vaccines this week, including newly designated hubs in some suburbs of Houston.

The hub providers include two in Galveston County, one each in Fort Bend County, Montgomery County and Liberty County and six in Harris County, according to a list of the hubs that are intended to focus on mass vaccination efforts. Officials plan to distribute 333,650 first doses of COVID-19 vaccines to 260 providers across the state. Additionally, the state will order about 500,000 doses expected to be the second ones for people who received their first shot a few weeks ago.

Earlier this month, the Houston region’s three hubs were all in Harris County, making officials in some surrounding counties fear they’d been forgotten. The Texas Department of State Health Services previously said more hubs were likely to be added but that the main obstacle was a short supply of vaccines.

“In the past week, Texas became the first state to administer 1 million doses of vaccine, and vaccine has been administered to residents of all 254 counties,” state health officials said in announcing the allocation breakdown of the week’s doses. “Vaccine remains limited based on the capacity of the manufacturers to produce it, so it will take time for Texas to receive enough vaccine for all the people in the priority populations who want to be vaccinated.”

The vaccine first arrived in Texas on December 14, so that million doses was administered over about five weeks, or less than 30K per day. Things have surely picked up since the first few days, with the emergence of hubs. We’re still working to get to that 50K per day minimum target, which as we have discussed is still a 20-month time frame. Getting the rate higher than that is going to depend on the federal supply, which was very much over-promised and under-delivered by the Trump administration. But today is a new day, and now we have a new President, and things should be looking up soon. Let’s all hope so.

Vaccine roundup

Just a few news stories (and a Twitter thread) of interest from recent days.

How do you get a COVID-19 vaccine? In Texas’ rollout, it’s a game of luck and chance

Still, the contrast shows just how sharp and seemingly random the divide has emerged between those who are able to get the vaccine easily and those who cannot. In the fourth week of Texas’ vaccine rollout, a dermatology practice in Bellaire got 300 doses while Hope Clinic, which serves Houston’s poor and immigrant communities, got 100, according to the state’s most current list.

County registration hotlines have crashed under the volume of applicants while some doctors reported fielding calls from friends asking how to move to the front of the line.

In the month since the vaccines got federal approval, getting them into arms of the most vulnerable has been anything but smooth. Distribution has lagged. Demand has far outstripped supply. Critics call it yet another chapter in the failed government response to a virus that arrived nearly a year ago.

“There does seem to be no discernible distinction between those who are getting the vaccine and those who aren’t,” said Elena Marks, CEO of Houston’s Episcopal Health Foundation, an organization that works to improve health care access for poor.

Such unevenness is happening not just among the public but also within the medical community. At some small and midsize private practices, access to the vaccine remains elusive for front-line health care workers who regularly treat COVID patients, doctors say. Yet employees of large medical practices and big-name facilities are vaccinating staff that is not in direct contact with patients and in some cases working from home.

Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance

Texas has largely left the vaccine rollout process in the hands of local providers like Tarrytown Pharmacy, one of more than 1,000 providers approved to vaccinate Texans. And outside of dictating the first two groups allowed to receive it, providers say the state has given little instruction or information on when allotments will arrive, how immunization operations should be organized and what principles ought to be followed in prioritizing within groups 1A and 1B.

As they spearhead vaccination in a state of 29 million people, hospitals, pharmacies and community health centers alike across Texas built new scheduling systems from scratch, struggled to sync their patient information systems with the state’s and answered to an increasingly anxious public wondering when their turn for the shot will come — all while helping fight the COVID-19 pandemic during its highest peak in Texas.

“Every space I have is booked. I have phones going off the hook saying, ‘Where’s mine?’” said Dr. James McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. “The demand is insatiable right now. Everybody wants it today, and we just don’t have enough vaccines. It will take months.”

The state’s initial allocation of 1.2 million doses had been shipped by Jan. 3, according to state health officials, and another January shipment was expected to bring the state’s total allotment to 1.7 million. That’s still hundreds of thousands of doses short of the roughly 1.9 million necessary to provide just a first dose of vaccine to those Texas health care workers and residents of long-term care facilities eligible in group 1A.

But before many of those first in line had received a dose, the state allowed providers to start administering the vaccine to the second group — about 8 million people older than 65 or at least 16 with certain medical conditions. A Department of State Health Services official said there is some overlap between groups 1A and 1B (doctors and other health care workers over age 65, for example).

The sudden announcement to open vaccinations to the second group — just a week after the first distribution of vaccines for the first group — caught many providers off guard.

“It was in response to all of the chatter and angst to ‘Oh my God, they haven’t given all their vaccines out,’ and it’s been five days,” said McCarthy of Memorial Hermann. “I thought we would get all the health care workers done, and then we would move on. I didn’t think we’d be doing them simultaneously.”

Greg Abbott’s Politics Create a Vaccine Stampede

But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”

In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.

There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.

Advocates worry vaccines will be out of reach for Black and Hispanic neighborhoods devastated by COVID-19

COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.

“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn’t availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I’m very nervous and anxious that this [vaccination effort] is not going to work out for us.”

According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.

And, just as a reminder:

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

New year, same story. We deserve so much better. We’ll get better soon from the federal government. When will we get it from our state government?

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

Coronavirus 2.0

Happy New Year.

The first known case of a new and possibly more contagious coronavirus strain has been reported in Texas, in an adult male resident of Harris County who had no history of travel, according to the state health services department and County Judge Lina Hidalgo.

The variant known as B.1.1.7 was first identified in the United Kingdom, where it has spread quickly, and cases have been found in several U.S. states, including California and Colorado. It does not cause a more severe disease, and vaccines “are expected to be effective against it,” the health services department said, citing the existing scientific evidence.

“The fact that this person had no travel history suggests this variant is already circulating in Texas,” said Dr. John Hellerstedt, commissioner of the state’s health services department. “Genetic variations are the norm among viruses, and it’s not surprising that it arrived here given how rapidly it spreads.”

While this variant doesn’t appear to be any nastier, as far as we know, and should still be covered by the vaccines, it is apparently capable of spreading faster. Really makes you want to stay away from people, doesn’t it?

On the plus side, maybe.

State officials will start distributing most of Texas’ vaccine doses next week to a handful of large pharmacies and hospitals, creating “vaccination hubs” where more people can get a shot quickly, the Department of State Health Services announced Thursday.

“As the vaccination effort continues to expand to people who are at a greater risk of hospitalization and death, in addition to frontline health care workers, these vaccination hubs will provide people in those priority populations with identifiable sites where vaccination is occurring and a simpler way to sign up for an appointment with each provider,” the department said.

Those hubs could vaccinate more than 100,000 people next week, officials said.

DSHS issued a survey earlier this month to vaccine providers gauging their ability to operate community vaccination sites. The state will release the final list of large-scale providers later this week, after the federal government decides how many doses Texas will receive next week.

We expect another 200K total doses next week as part of this preparation. That’s good, but as we’ve discussed before, the numbers remain daunting. Texas has almost 30 million people in it. At 100K shots a week, you’re looking at six years to get everyone vaccinated. The optimistic interpretation of this story is that 100K per week is a starting point, and we’ll accelerate from there. Great, I sure hope so, but if we want to get enough of the state done to get close to herd immunity this year, we need to get to 500K per week, and every week we operate at less than that makes the target number have to be a little higher. (A better and more organized federal response will surely help.) I know, it’s a hard problem, everyone’s doing the best they can (well, not really, but let’s be generous for these purposes), and so on, but this is the math. As someone once said, the stars may lie but the numbers never do.

There is a website for COVID vaccine signups in Houston

You can’t use it right now, but it’s there.

Houston’s Health Department launched an online portal for residents to apply for an appointment at its COVID-19 vaccine clinic Monday but quickly ran out of available slots for the remainder of the month.

“The response to Houston’s first COVID-19 vaccine clinic was massive, quickly filling the appointment slots for the department’s current vaccine allocation,” Mayor Sylvester Turner said at a City Hall news conference where he was about to get his own shot in the arm.

“The vaccine clinic appointments are booked for the rest of this month, and the department is not taking additional appointments at this time.”

Turner said the city is working to set up additional sites and create additional capacity, although it is unclear when new appointments will be available. Turner said the city hopes to open a “mega site” on Saturday.

The portal, available at houstonemergency.org/covid-19-vaccines, added another way for qualifying residents to book for an appointment. A hotline also is available at 832-393-4220.

The city clinic vaccinated nearly 2,000 residents with the Moderna vaccine in two days. It is accepting residents from the first two phases of the state’s distribution plan, which include front-line emergency workers, people 65 and older, and those over 16 with certain high-risk health conditions.

It’s a good start, but at 2K shots a day, we’re talking two years to get to 75% distribution in the city. We’d like to go a little faster than that. Obviously, the city is limited by how much vaccine it can get, as well as the state regulations. Harris County had its own rough rollout thanks to confusion over who was allowed to sign up. On that first front at least, help is on the way, so maybe in another month or two we’ll see much higher numbers. And at least there is now a central location for this for Houston residents, something that had been sorely lacking before.

There’s some more vaccine coming to Texas, but it’s still not a lot.

On Monday, state health officials announced that 325,000 additional vaccine doses would be getting into the hands of 949 providers in 158 Texas counties over the next week, part of the first round of vaccinations for front-line health workers as well as nursing home residents, Texans over 65 and those with certain medical conditions, among others. Some 121,875 doses are earmarked for long-term care facilities such as nursing homes and assisted-living centers.

But with the number of vaccine doses available still falling far short of what’s needed to cover those who are eligible — and with state officials pushing hospitals and other providers to administer vaccine doses that the providers say they don’t have, aren’t sure are coming or have already administered — confusion and frustration have surrounded the initial few weeks of the vaccination rollout.

Providers have 24 hours to report their vaccination statistics to the Department of State Health Services, and the agency updates its numbers each afternoon with data reported by midnight the day before, so the state’s numbers could lag up to two days behind the reality on the ground.

Officials from the White House down to local doctors have warned that it would take months to have vaccine doses available to everyone who wants one.

“The problem is unrealistic expectations based on the reality on the ground,” said Marshall Cothran, CEO of the Travis County Medical Society, which received 700 doses through a local partnership and had them all scheduled within 48 hours for physicians and staff who are not affiliated with hospitals or other care organizations.

With the new shipments this week, the state has been allotted a total of 1.5 million doses through the first four weeks of distribution, officials said Monday. Providers in 214 of the state’s 254 counties will have received shipments by the end of the week, health officials said.

Some 793,625 doses had been received by providers by midnight Sunday, according to the Texas Department of Health Services.

Of those, 414,211 — just over half of those delivered — had been administered, according to the agency’s dashboard.

Hardesty said the nearly 16,000 doses his facility received are being administered “fast and furiously,” and about 10,000 people have gotten their first dose, with second doses to start in the next week.

“We’re giving them as quickly as we can,” he said.

I don’t doubt that, but let’s be clear that 1.5 million doses is five percent of the state’s population, and that 414K is just a bit more than one percent. Seven hundred doses for Travis County, with 1.3 million people, is a drop in the bucket. If you vaccinated 700 people a day in Travis County, it would take you six years to get everyone. In the end, this won’t take anywhere near that long, but we are talking months, and in the meantime the hospitals are also dealing with an insane surge in new cases. I can’t emphasize enough how much we needed to keep a lid on this, and how badly we failed at that.

Anyway. Here was the Harris County website for vaccine registration, which is still up but doesn’t have any method for signing up for a COVID shot at this time. Dallas County has its own website, while Bexar County had a similar experience as Houston did. It will get better, I’m sure, but the early days are going to be chaotic.

How’s the vaccine rollout going?

Not very quickly.

Top Texas officials again urged health care providers to administer more coronavirus vaccines Tuesday, the same day the state reported that the proportion of Texans whose coronavirus tests come back positive has hit levels not seen since a summer wave of cases that overwhelmed some hospitals.

The state reported Tuesday that 163,700 Texans had been vaccinated with at least one dose of the vaccine. About 1.2 million doses have been allocated to providers across the state through the first three weeks since their arrival, according to the Department of State Health Services.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Gov. Greg Abbott said in a tweet Tuesday evening.

That tweet came after health officials asked providers that received doses of the COVID-19 vaccine to “immediately vaccinate” all eligible Texans, including people 65 and older and those who are at least 16 with a qualifying medical condition. That renewed push echoed a statement Dr. John Hellerstedt, commissioner of the Texas DSHS, sent to providers last week directing them to “administer their entire allotment with all deliberate speed.”

“Dr. Hellerstedt put out that statement today to make it clear to all providers that people over the age of 65 and people with medical conditions that put them at greater risk of severe disease of death from COVID-19 are eligible to receive vaccine now,” said spokesperson Douglas Loveday. “Vaccine supply remains limited but more vaccine will be delivered to providers each week. It will take time to vaccinate everyone in those priority groups.”

To be fair, lots of states are stuck in low gear right now, but even accounting for that, Texas is in the back of the pack. There are distribution problems, and there is confusion over who can get a vaccine and where and how they can get it.

A single state website and hotline, with accurate and updated information about vaccine locations and supplies sure would be nice. What we have here evokes the old proverb that a person with one watch knows what time it is, and a person with two watches is never sure. Maybe when Greg Abbott and Ken Paxton are finished harassing the city of Austin, they can spend a few minutes thinking about that. In the meantime, hospitals are pushing back against the claim that they are the bottleneck.

The state’s largest hospital association is pushing back against a suggestion from Gov. Greg Abbott and the state’s top health official that a large number of coronavirus vaccines could be going unused in Texas hospitals.

The back and forth comes as the state vaccine dashboard shows that just 205,463 Texans had received the first dose of the coronavirus vaccine as of midweek, although 678,925 doses have been shipped around the state.

Abbott and Dr. John Hellerstedt, the commissioner of the Texas Department of State Health Services, sounded the alarm Tuesday, urging health care providers to begin vaccinating people 65 and over and those with underlying health conditions, including pregnant women, if they have concluded the first phase of vaccinations.

But most hospitals in the state are still vaccinating the first group of eligible Texans — hospital staffers working directly with coronavirus patients; long-term care residents and staff; emergency workers; and home health care workers — or have not yet received any shipments of the vaccine, according to Carrie Williams, spokeswoman for the Texas Hospital Association, which represents more than 85% of the state’s acute-care hospitals and health care systems.

“Vaccine is not sitting on hospital shelves,” Williams said, suggesting the state’s immunization reporting system has caused delays in reporting data. “With regard to data, we have no certainty it is accurate at this point in time. The number of doses administered is higher than what’s indicated.”

While the number of vaccines shipped across Texas is accurate, there have been “varying reports of the actual number of vaccines administered,” a spokesman for the Texas Division of Emergency Management said Wednesday.

The agency launched a website Wednesday showing up-to-date numbers of vaccine doses and therapeutics available at health care providers.

Abbott spokeswoman Renae Eze touted the website as a source of “real-time reporting system to show vaccine usage data from health care providers across Texas.”

The site, however, does not show how many COVID-19 vaccine doses have been administered.

[…]

For their part, hospital directors say the call from state leaders to move onto the next tier of vaccinations has caused chaos across the state as hospitals try to manage a vaccine rollout and a growing number of COVID-19 patients, Williams said.

“Hospitals are being flooded with calls from the general public seeking vaccine, which creates further operational challenges,” she said. “And, there are still hospitals that have not received any vaccine for their frontlines.”

The story doesn’t indicate what the URL of this new website is. The TDEM website is here, but all I found on a cursory search was information about testing, not about vaccines. This WFAA story about the bumpy vaccine rollout says that this DSHS page is the state’s main vaccine information center, but it’s mostly about eligibility. The story also reports, as Miya Shay did in her tweet, that DSHS and TDEM have two different maps showing providers who have received vaccine doses, and advise people to reach out to providers with their questions. That is not going to help with the flood of questions hospitals are already getting. Meanwhile, State Rep. Donna Howard tried to answer some questions on Twitter:

You can read the thread, but it largely comes down to lags in reporting, the timing of distribution, and confusion over who is eligible. For a guy who’s emphatically rejected calls for further COVID restrictions because the vaccines will save us all, you’d think Greg Abbott would want to put more effort into getting the vaccine distribution part of it right. Just a thought, but maybe this should be a campaign issue next year. What has been your experience trying to chase down a vaccine, for yourself or for a family member?

UPDATE: Later last night, the Trib published this longer story that covers all of the topics I’ve touched on here and more. At some point, Greg Abbott really needs to feel some heat for this.

A new high in hospitalizations

This is fine.

The Texas Department of State Health Services reported Monday a pandemic high 11,351 hospitalizations from COVID-19.

This surpasses the previous all-time high of 10,893, which occurred on July 22.

The record comes in the midst of a holiday season public health experts worry could exacerbate the already rapidly spreading virus and following an increase in cases weeks after Thanksgiving.

This hospital data does not account for people who are hospitalized but have not gotten a positive test, and DSHS says some hospitals may be missing from the daily counts. As of Monday, the state is also reporting 49 deaths from COVID-19, a lagging indicator of the extent of transmission rates, and more than 12,800 new confirmed COVID-19 cases. Reported cases may have appeared lower the last few days because some local health departments did not report data to the state over the holiday week.

Earlier this month, Texas’ ICU capacity was already the lowest since the start of the pandemic, leaving health care experts worried hospitals could be pushed to the brink as coronavirus cases continue to climb. Across the state, COVID-19 patients occupy 17.8% of the state’s hospital beds, and only 745 staffed ICU beds are still available.

At a press conference Monday, Mark Escott, Austin’s interim medical director and health authority, said that this week alone, “ICU utilization” is up 62% in Travis County and that hospital beds could become scarce in a matter of weeks.

“Our projections forward into the new year continue to look worse and worse day after day,” Escott said. “I think right now it appears we’re going to enter 2021 in a state of emergency.”

This is fine:

This is fine:

Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, said he anticipated a major fall surge amid a wave of new infections in West Texas and the Panhandle.

Those areas are among the hardest hit in the country, he said.

“Up in Midland and places like that, it’s still a really tough area,” he said, adding, “In terms of surges, I’m maybe a little less worried about the Texas Medical Center. But in other parts of the state, it’s going to be a real concern.”

There are 745 ICU beds available across the state, according to data from the Department of State Health Services, the lowest number available since the pandemic’s surge during the summer. Among 63,679 staffed hospital beds, 13,416 are available statewide.

Further, 15 of the state’s Trauma Service Areas are reporting that more than 15 percent of their total hospital capacity is taken up by COVID-19 patients, crossing the threshold for what the state considers “high hospitalizations.”

At the Texas Medical Center, the weekly average of new COVID patients has more than doubled since early November, from 104 to 248. Medical center data from Sunday shows 1,594 total COVID patients and another 404 in the ICU. There are 1,298 total occupied ICU beds with hundreds more available, the data shows.

“The medical center has gotten a lot of heft, in terms of being able to accommodate COVID patients,” Hotez said.

[…]

The sporadic use of masks has contributed to the surge, said Hotez, adding that he doesn’t anticipate the number of statewide hospitalizations decreasing anytime soon. He noted that the number of beds is less of a concern than the number of trained staff available.

Hotez said he did not know how much Christmas gatherings would impact the number of infections. But he warned people that New Year’s celebrations would be the “best party the COVID virus can hope to have.”

“I would just say any kind of New Year’s celebration is fraught with risk ,” he said. “Because when you have this high level of transmission going on in the state, anytime you bring four or five people together, there’s a good likelihood they’re going to have COVID.”

I’m really scared for what the next few weeks may bring. Wear your mask, practice social distancing, avoid indoor gatherings, and try to survive until you can get vaccinated.

Next in line for the vaccine

Attention will shift to more vulnerable populations.

Texans who are 65 years old and older, and those who are at least 16 with certain chronic medical conditions will be next in line for the COVID-19 vaccine, the Texas Department of State Health Services announced Monday.

“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” said Imelda Garcia, chair of the state Expert Vaccine Allocation Panel and DSHS associate commissioner for laboratory and infectious diseases. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”

The vaccine, which arrived in Texas on Dec. 14, has been available so far only to front-line health care workers and residents of long-term care facilities. There are nearly 1.9 million Texans in that group, so it will likely take a few weeks before the state transitions to the next phase, state health officials said.

The state expects to receive 1.4 million vaccine doses by the end of the month. Eligible facilities under the current phase include hospitals, pharmacies, nursing homes and Texas Department of Criminal Justices facilities.

The city of Houston will also receive 6,000 doses that are ticketed for firefighters and health care workers, so that’s good. A list of comorbidities that would get you onto the eligible list for the vaccine is in the article, so click over and check it out if you think this may apply to you or someone you know. But do keep in mind that bit about it taking a few weeks to transition into that next phase, because it will take awhile to get through the first phase. We need to continue to practice prevention so as not to sicken and kill many more people needlessly.

Indeed, for those of us in Houston, the next few weeks are looking rough.

The spread of COVID-19, steadily increasing in Houston and Texas since the beginning of November, is expected to accelerate in coming weeks, according to the latest modeling, a trajectory that could make the city and state one of the nation’s next hot spots.

The models project COVID-19 numbers — cases, hospitalizations, deaths — to continue rising in Houston and many other parts of Texas before likely peaking sometime in January. Parts of the state at crisis levels the past month have peaked.

“There’s a lot of concern about the Houston area as we enter the Christmas season,” said David Rubin, a pediatrician and director of The Children’s Hospital of Philadelphia’s PolicyLab, which produces one of the models. “If I were to say what areas in the country still have the potential to surge, the Houston area definitely would be one of them.”

Rubin and others urged everyone to hunker down over the coming holiday period in an attempt to limit the damage from the coronavirus’ seeming last onslought before gradually deployed vaccines can begin to shut down the pandemic. He noted widespread deployment won’t be in time to affect Houston’s winter peak.

[…]

“What’s concerning is that so many regions of Texas look to be hit about the same time,” said Spencer Fox, associate director of the UT COVID-19 Modeling Consortium. “It’s a sad trend at a time when the vaccines are almost within reach.”

The Houston-area trends are worrisome in two of the models. Fox’s group projects 2,121 COVID-19 hospitalizations in the area on Jan. 15, for instance, an increase of 36 percent over the 1,561 such admissions for Dec. 17.

In addition, the CHOP PolicyLab modeling shows the number of Harris County COVID-19 cases should nearly double by the end of the first week of January. The model projects 2,919 cases on Jan. 7, up from 1,478 on Dec. 14.

A third forecast, by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), projects the number of deaths in Texas will peak Jan. 5 at 292. The model, the only one of the three that projects more than a few weeks out, says daily deaths would total 280 on that date assuming universal mask wearing but reach 345 by late January if mandates are eased.

Thanks partly to the vaccines, the IHME model projects the number of daily Texas deaths will decrease dramatically after the Jan. 5 peak — 138 on Feb. 1, 55 on March 1 and 17 on April 1. The vaccine’s most immediate effect is expected to be more of reducing severe illness and deaths than cases.

The IHME model does not project past April.

In all, 28,134 COVID-19 Texas deaths are expected as of Dec. 31, according to the IHME model. All but 2,700 of those came after June 30.

“That’s a devastating loss of lives in just a six-month period,” said Dr. Peter Hotez, a Baylor College of Medicine infectious disease specialist and vaccine scientist. “Has Texas ever lost so many lives in such a short time?”

The CHOP PolicyLab foresaw the June/July spike, though they were more alarmist than the situation turned out to be. But between the holidays and the colder weather that makes outdoor dining less feasible, the conditions are certainly there for an uptick. We all know what to do about this, it’s just on us to actually do it.

We still need more than the vaccines

The vaccines are great, don’t get me wrong, and they couldn’t have come at a better time, but they’re going to take awhile to be administered, and in the meantime a whole lot of people are still getting sick and dying.

Gov. Greg Abbott on Thursday applauded the arrival of the new coronavirus vaccine, calling it a “monumental medical miracle” as he sought to boost morale amid some of the pandemic’s toughest days.

Speaking outside a UPS distribution center in Austin, the governor painted an especially rosy picture of the weeks ahead, promising a swift vaccine rollout even as national supplies are limited and the state is reporting high numbers of new daily infections. Hospitals in some cities across Texas have been overrun with COVID-19 patients.

The vaccine, which began rolling out on Monday, “is on a daily basis saving lives and beginning to restore normalcy in our community,” Abbott said.

About 90,000 doses have been distributed in Texas already, and another 150,000 were being shipped out on Thursday. The first batch is intended for health care workers treating COVID-19 patients.

State health officials are still determining whom to prioritize from there, including teachers, public safety employees and prisoners. The governor himself has yet to be inoculated but said he plans to at “the appropriate time.”

Texas expects to receive 1.4 million doses by the end of the year, not quite enough to treat all of the 1.6 million health care workers who would be eligible.

[…]

State and national health experts have cautioned that it will be well into 2021 before vaccines become widely available and that infections will continue to spread as long as some resist safety measures such as physically distancing and masking in public.

“It’ll still be weeks, perhaps months, before it is absolutely available to anyone who chooses to have it,” said John Hellerstedt, commissioner of the Texas Department of State Health Services. “In the meantime we need to continue the kinds of things that have gotten us this successful so far.”

Abbott has so far refused to tighten the state’s mask mandate or impose other new restrictions, even as county officials have asked for them as they battle new waves of infections. On Monday the state reported nearly 18,000 new confirmed and probable cases, as well as 252 deaths. More than 24,000 Texans have died from COVID since March.

For a very sobering look at where we’re headed, read this:

What is the one thing that could mitigate this? Another lockdown, with a mask mandate alongside it. What is the one thing that could mitigate the devastating economic effect of another lockdown? A truly adequate COVID stimulus package from Congress. What are the two things Greg Abbott is never going to do? You get the picture.

There’s also this.

The start of COVID-19 vaccinations for health care workers has sparked hope that the end of the pandemic crisis is within sight, but when it comes to vaccine distribution, this is still the easy part. Local and state health agencies say they will struggle to get hundreds of millions of doses of the vaccines to the general public without a huge amount of additional funding. Even if Congress does manage to pass a compromise relief bill, the amount it provides may not be enough.

The fates of the vaccine and the relief bill, both months in the making, are linked. The $900 billion proposal that Democrats and Republicans on Capitol Hill continue to debate has a number of provisions to mitigate the COVID economic crisis, including additional unemployment benefits and small business support. The latest available version also contains $6 billion in vaccine distribution funding for state and local health departments. But groups that represent state and local health departments say that this funding, while crucial, won’t be sufficient to distribute the vaccine on a massive scale as efficiently and widely as possible.

“We see the $6 billion that’s on the table as an important down payment to scale up staffing, develop and enact communications plans to address vaccine hesitant populations, and enroll more vaccinators,” Jasmine Berry, the communications director at the Association for Immunization Managers, says in an email. “There’s still going to be a need for additional funding for state and local health agencies.”

What’s more, the already months-long delay in getting this funding to state and local health departments may create problems down the line, as the country’s vaccination campaigns expand beyond health care workers and nursing homes.

“Where we’ll really start to see potential delays, or where we are not as successful as we could have been, may be as we move through the phases to the next group, where there’s a much larger population that would need to be served,” says Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials, which represents local health departments.

How much of the vaccination tab are Greg Abbott and the Legislature willing to pick up if Mitch McConnell continues to block any COVID relief bills from passing? A miracle’s no good if you can’t access it.

Abbott is right that the vaccines will save lives and restore normality to our lives. But only if we live long enough to get vaccinated, and only if the funding is there to make sure everyone can get vaccinated. These things aren’t going to happen by themselves.

The regional COVID situation

Not great, Bob.

COVID-19 is surging across southeast Texas, especially in the suburban counties outside of Houston, which have seen a steady increase in the number of new cases, data show. Galveston, Chambers, Brazoria, Liberty, and Montgomery counties have all had higher COVID-19 cases per capita than at any point during the pandemic. Chambers County leads the region with 463 virus cases per 10,000 residents, followed by Galveston County with 433 cases per capita, according to data compiled by the Houston Chronicle.

Experts say the latest spike is driven by a combination of factors — public fatigue from basic COVID-19 restrictions such as mask wearing and social distancing, but also more family gatherings in households and larger groups in bars and restaurants. While case counts are consistently much higher than they were in previous weeks and months, they have yet to equal the peak seen during the summer.

Yet the virus’s resurgence in places like Galveston County has put business owners like Railean on edge, owing to an executive order from Gov. Greg Abbott that could trigger new restrictions — including the complete closure of some bars — if regional virus hospitalizations exceed 15 percent of hospitals’ total bed capacity for seven consecutive days. At a time when thousands of restaurants — as many as 10,000 across the state, per the Texas Restaurant Association — have closed due to the COVID-19 pandemic, further closures could be catastrophic for the industry.

“It would be absolutely devastating to lose this holiday season, devastating to our businesses,” said Gina Spagnola, president of the Galveston Chamber of Commerce.

The Texas Department of State Health Services divides each of the state’s 254 counties into 22 “trauma service areas” which coordinate systems of emergency healthcare and preparedness for their respective regions. Galveston, Chambers, Brazoria, and Liberty Counties are part of a nine-county region trauma service area where COVID-19 hospitalizations have spiked significantly since early November. On Saturday, the region’s rate of hospital beds in use by covid-infected patients eclipsed the 15 percent mark for the first time before dipping back down to 13 percent by Tuesday.

After seven consecutive days above that 15 percent mark, per Abbott’s executive order, the state health agency would notify county judges in all nine counties of the following restrictions: hospitals must suspend elective surgeries; businesses including restaurants, retail stores, offices gyms, and museums would be limited to 50 percent capacity; and bars and other establishments with more than 51 percent alcohol sales must close.

I wish the Chron had included the comparable number for Harris County. I tried computing it myself based on the Chron’s coronavirus page and 2019 Census numbers I found on Wikipedia, but I got higher totals for Chambers and Galveston than what the story gives. The Harris County number I calculate by the same method was lower than those two, but I don’t know how to adjust them, so we’ll leave it at that. I could still probably make a moral comparison between Harris’s more strenuous effort to combat the virus and the more lax attitude of some neighbors, but I don’t know what that would accomplish at this point. The bulk of the blame for all this remains with Donald Trump, Greg Abbott, and the Senate for not passing further COVID relief, which among other things might have helped all these businesses to survive without being open. We can’t wind the clock back and make Trump take COVID seriously, but we could still do the stimulus. Greg Abbott could still tell our Senators to demand that the Senate pass something that would help our state and our businesses. I’m going to keep saying that, every time. On so many levels, it didn’t have to be like this.

The vaccine distribution challenge

Having a vaccine for COVID-19 is wonderful. Being able to make it available to everyone who needs it is a big challenge.

With cases spiking to over 10 million, the virus is everywhere, and spreading deeply into every corner of the country. This is where the Biden administration will face its biggest challenge, especially as it pertains to rolling out a potential vaccine.

My home state of Texas is a great example. A 2016 report from the Texas Department of State Health Services illustrates the terrible state of rural health care. According to DSHS, 235 of Texas’ 254 counties were medically underserved. There were many isolated counties with little to no access to health care. Some even lacked a single doctor.

This has been a crisis a long time in the making. As the Texas Observer recently noted, in 2019, Texas budgeted $17.7 million for infectious disease surveillance, prevention, and epidemiology—and over $400 million for border security. So even when a vaccine is delivered, it will be going to a state that is understaffed and underfunded.

Lipscomb County, population 3,302 as of 2010, in the northeast corner of the Texas panhandle, doesn’t have a doctor. It is worth noting that Lipscomb County is a 550-mile drive from Austin. Portland, Maine, is a closer drive to Washington, D.C., than those 3,302 isolated souls.

Given this isolation and lack of resources, the vaccines themselves present a logistical challenge alone that borders on the impossible for rural America. The Pfizer vaccine, now the leading contender, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another leading vaccine candidate from Moderna also requires cold storage, albeit not to the same extent, according to the company. Typically, hospitals and large clinics have this capability. Small towns lacking even the most basic health clinics do not.

To deploy the Pfizer vaccine or any other one, health planners will have to figure out a way to deliver it to rural areas while maintaining its required temperature long enough to ensure that the population receives both doses. This scene will be repeated all across small-town America. This presents a big risk: An uncoordinated federal roll out of vaccines requiring ultra-cold storage could leave state and local governments competing for resources much like they were competing for PPE earlier in the pandemic.

The Trib expands on this.

How effectively public health officials can prioritize and distribute millions of doses of the new vaccines across a state that covers 270,000 square miles and more than 170 rural counties will determine how quickly Texas turns a corner in a pandemic that is again surging across the state and pushing hospitals to the brink in West Texas and the Panhandle.

The task is made more difficult because the Texas Department of State Health Services, which is largely responsible for the distribution effort, won’t know which vaccines it’s receiving, and how many doses, until one or more is approved by the U.S. Food and Drug Administration.

They will also have to combat misinformation and persuade vaccine skeptics — and those unnerved by the coronavirus vaccines’ historically swift development — of the benefits of being inoculated. World Health Organization experts have said that up to a 70% vaccine coverage rate for COVID-19 may be needed to reach population immunity through vaccination. In the 2019-20 flu season, only about 37% of adults younger than 65 received a flu vaccine. The rate was about 65% for seniors.

“We haven’t seen any efforts that are this broad since probably a polio vaccination in the 1950s,” said Dr. Mark McClellan, a former head of the FDA who has advised Abbott about the pandemic.

“The people who are most likely to benefit from vaccination are people who may have difficulty connecting to health care,” such as elderly people and residents of low-income communities who often lack health insurance, he added — compounding the logistical challenges.

The vaccine is expected to initially be in short supply, and will be first distributed to a state-selected group of people considered to be essential workers or most vulnerable to being severely sickened.

[…]

It’s still unclear, beyond a list of murky priority groups such as health care workers, who will get the vaccine during the initial months when supplies are scarce. In the coming weeks, a state panel of experts is expected to publish more specific recommendations about who will be eligible for a vaccine and when.

Early estimates from the Texas Department of State Health Services found there are more than 5 million people who are vulnerable or work in front-line jobs that increase their exposure risk. That includes more than 3.9 million people who are 65 or older, more than 638,000 health care personnel, more than 327,000 acute care hospital employees, more than 137,000 nursing home residents and more than 66,000 emergency medical workers.

The state’s adult population also includes more than 9.4 million Texans with underlying medical conditions that could increase their risk for severe illness associated with COVID-19.

So yeah, it’s a big problem, and there are many questions that need to be answered, some of which will spark heated debate. In the meantime, as both stories noted, the pandemic rages on, meaning we could be trying to vaccinate people while we’re still in conditions that still demand social distancing and will put everyone involved in the process at risk. So you know, maybe we should try a little harder to contain the spread right now. Just a thought.

UPDATE: From the Trib:

Health care workers will be the first people in Texas to receive a COVID-19 vaccine once one receives emergency approval from the U.S. government, and on Monday a state panel of vaccine experts and politicians revealed which workers in the health field will receive top priority.

The “first tier” recipients, according to the panel’s new guidelines, include:

  • Hospital-based nurses, doctors, custodians and other workers who have direct contact with patients
  • Staff of nursing homes or other long-term care facilities who work directly with residents
  • Emergency medical services providers such as paramedics and ambulance drivers
  • Home health aides who manage “vulnerable and high-risk” patients

Certainly reasonable. We’ll see how it goes after that.

We’re number one (million)!

One million COVID cases in Texas. Hooray?

Texas’ grim distinction as the national leader in terms of COVID-19 infections came as little surprise to some local medical experts, who blamed politicians for conflicting messages about the virus and warned the worst is yet to come.

Texas this week breached a milestone of 1 million cumulative cases since the start of the pandemic, recording more infections than any other state in the U.S. For reference, more people have been infected in the Lone Star state than live in Austin, the state’s capitol.

If Texas were its own country, it would rank 10th in terms of total cases, according to data from Johns Hopkins University, placing it higher than European hotspots like Italy.

The big numbers are not a shock in a state that’s home to roughly 29 million people. The number of cases per 100,000 residents is lower here than in about half of the states in the country. But Texas also had more newly reported cases in the last seven days — an average of about 8,200 — than other large, hard-hit states such as New York, California and Florida. Only Illinois has a higher seven-day average.

Dr. David Callender, president of the Memorial Hermann Health System, called the 1 million cases “a sobering statistic.”

“It’s not a surprise in the context of all that’s happened,” Callender said. “But it’s a significant number — 3 percent of the population — and cause for worry about the trend continuing as we go forward.”

Callender attributed the high number to “too much division” in the attempt to contain the virus.

“To me, politics entered in an inappropriate way,” said Callender. “People making a political statement with their behavior — that the pandemic is a hoax, that no one can make them wear a mask — really interfered with efforts. It was the wrong mindset.”

To be fair, California is a couple of days behind us, and may have passed one million by the time I publish this. Of course, California also has ten million more people than Texas, so.

The state’s positive test rate is now 11.24%, compared to 7.64% a month ago.

Hey, remember when a 10% positivity rate was considered to be a “warning flag” by Greg Abbott? You know, as part of his famous “metrics” for reopening the state?

Abbott’s office didn’t immediately respond to messages Tuesday.

Too busy propping up Donald Trump’s ego to deal with this kind of trivia, I suppose.

Meanwhile, in El Paso

The number of coronavirus patients in Texas hospitals has nearly doubled since October, and average infections are at their highest point in almost three months — leaving health officials bracing for a potential crush of hospitalizations going into the holidays.

In El Paso, hospitals are so overwhelmed with COVID-19 patients that in early November the Department of Defense sent medical teams to help, and the county has summoned 10 mobile morgues to hold dead bodies. Local funeral homes are readying extra refrigerated storage space, as the number of hospitalized coronavirus patients in the far West Texas city has shot up nearly tenfold since the start of September.

The new wave of infections stands in contrast to the summer surge, when Gov. Greg Abbott held regular press conferences about the virus and mandated that face coverings be worn, earning him the ire of the far-right. Now, state officials seem reluctant to crack down on the virus’ spread by further curtailing economic activity — and are fighting the El Paso county judge’s attempt to impose a curfew and a stay-at-home order in the face of record-breaking cases.

The state will not do anything to help, and you local leaders are not allowed to do anything to help. You’re on your own. If you’re very lucky, maybe you won’t have your health insurance taken away while you recover. Did I mention that disaster and emergency response ought to be a big theme of the 2022 election? Texas Monthly has more.

UPDATE: Nothing to see here.

Will Greg Abbott ever talk about COVID-19 again?

Signs point to No.

On Wednesday, Gov. Greg Abbott knocked on doors in the Fort Worth suburbs, fist-bumping with police officers and warning residents that Democrats want to raise their taxes.

That night, he opened Game 2 of the World Series at Globe Life Field in Arlington, belting out a hearty “play ball” before a stadium partly filled with cheering fans.

With the Nov. 3 election fast approaching, the state’s top Republican is in full campaign mode, trying to block Democrats from retaking the Texas House.

But away from the choreographed appearances, the governor is facing another challenge: Coronavirus infections are rising again, filling up hospitals in parts of the state. Unlike when cases mounted earlier this summer, Abbott has been all but silent about COVID-19’s resurgence.

The governor hardly has mentioned the uptick, which has been most severe in parts of North and West Texas. In news releases, he has announced that he’s sending resources and medical staff to hot spots, but he has downplayed or failed to even mention the outbreaks — part of a third wave sweeping the South and Midwest.

Abbott hasn’t held a public briefing on the pandemic in more than a month.

For a governor who made a point of being on television every night as cases spiked this summer, making himself the face of the state’s response, the silence is notable and likely strategic.

“There’s no advantage to Abbott coming out now to acknowledge the spiking numbers, which say Texas isn’t doing a good job, which say he isn’t doing a good job,” said Brandon Rottinghaus, a political science professor at the University of Houston. “With a week until the election, that would not be beneficial for him.”

[…]

Nearly 5,000 people were hospitalized Thursday with COVID-19, a 55 percent jump since Oct. 3. The average of new daily infections has been rising steadily for two weeks, and the rate of people testing positive for the virus is now just shy of 9 percent, after dipping to a low of 6.3 percent in September.

In Tarrant County, where Abbott appeared Wednesday, health officials have warned residents of substantial community spread, meaning the virus is being transmitted through workplaces and schools.

“The signs are pointing to a big surge coming,” Tarrant County public health director Vinny Taneja told WFAA-TV in Dallas on Wednesday.

Abbott has been an important figurehead in the state’s coronavirus response. When the number of people hospitalized with the coronavirus reached 5,000 in late June, he responded by closing the bars and cutting maximum occupancy for restaurants to 50 percent. He later issued a statewide mask mandate, which remains in effect.

Asked about the new trends Wednesday as he door-knocked for a fellow Republican, Abbott told reporters the state is preparing for a vaccine rollout as soon as late November, a claim that conflicts with remarks from top federal health officials.

The state’s own health officials aren’t planning for a wide rollout of a potential vaccine until July of next year.

Earlier this month, amid mounting pressure from conservatives, Abbott released a video announcing bars could open in counties with local approval, hoping to show a state that had put the worst of the pandemic behind it as voters prepared to head to the polls.

“The good news is that even with more businesses opening, even with more students returning to school and more gatherings like football games, Texans have shown that we can contain the spread of COVID,” Abbott said.

Anyone remember Abbott’s four metrics for reopening? Because I’m pretty sure he doesn’t at this point. Part of the problem, I admit, is that everyone is focused on the election – I sure am – and that means there’s basically no public pressure on Abbott to take action. But this has been building for weeks, and we’ve got kids back in schools while bars are open and people are attending live sporting events – college football appears to be a non-trivial factor in community spread – while a bunch of jackasses are going around the state demanding that we open up even faster. And of course there’s a malevolent President who’s doing all he can to ensure that things are getting worse. Is anyone surprised that Greg Abbott can’t be bothered to at least remind everyone that they should be wearing masks and avoiding crowds?

As little as I think of Abbott, I do expect he’ll have to start talking about this again after the election. If nothing else, we’ll be embarking on a legislative session soon, and we need to decide how we’re going to handle that. I just hope we get something that resembles leadership from Abbott before too many more people are hospitalized or dead.

And so the re-reopening begins

Are we really ready for this?

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We suck at COVID data, the continuing story

Would have been nice to have known this when it was happening.

State health officials published new data this week that showed the state’s positivity rate was higher in the spring that originally disclosed, even as public officials cited the data to justify business reopenings during the pandemic.

The Department of State Health Services on Monday announced a new method for calculating the positivity rate, or the proportion of positive tests, and conceded the previous method obscured the extent of viral transmission by combining old and new cases. The new formula relies on the date a coronavirus test was administered, rather than the date it was reported to health officials and verified as a case.

As Texas prepared for the first phase of reopening in late April, Gov. Greg Abbott repeatedly pointed to the state’s positivity rate, even as the number of new cases and deaths continued to rise. Announcing his initial reopening order on April 27, Abbott declared that the “COVID-19 infection rate has been on the decline over the past 17 days.”

The following week, the governor downplayed a new single-day record in new COVID-19 cases by again pointing to the positivity rate.

“Despite concentrating on areas where we think there may be a high level or number of people who could test positive, the fact remains that more than 95% of the people who were tested test negative,” Abbott said during a May 5 news conference.

State data at the time placed the seven-day average positivity rate at 5.84%, near the 5% benchmark recommended by the World Health Organization before governments ease restrictions. The actual rate, however, was higher. According to the new method employed by DSHS, Texas’ seven-day average positivity rate was actually 8.4%, near the 10% threshold Abbott had called a “warning flag” indicating a high level of community spread.

Following the reopening of bars, restaurants, stores and child care centers throughout May, Texas saw a surge in cases beginning in June. The state’s reported seven-day average positivity rate under the old method jumped from 4.27% at its lowest point in late May to 17.4% at its peak in mid-July. After revising the data, the state’s new chart shows that the positivity rate jumped from 5.81% in May to a peak of 21% in early July.

See here, here, and here for earlier entries in this chronicle. This stuff is hard, I don’t want to minimize that. Doctors and scientists have made mistakes and have changed their tune on COVID-related matters over time, as new data has come in and revised our understanding of what we thought we knew. Maybe no one could have known this at the time, I’m not in a position to judge. But as we’ve said before, the state rushed to reopen on Greg Abbott’s orders even as the Abbott-defined metrics for reopening were not being met. Now we know we were even further from the desired levels than we thought, and many more people have gotten sick and died or are suffering from long-term effects of the virus. We can have some level of sympathy for Greg Abbott, we can recognize that anyone would have made bad decisions if they were given bad data, and still hold him responsible for the outcome. His decision to reopen as he did was risky at the time, and it’s so much worse now. That’s all on him.

Who knows what our positivity rate is?

From the We Still Suck At Data Department:

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

Time for another COVID roundup

Let’s start with some good news, which comes wrapped in a warning.

The number of coronavirus patients crowding hospital wards in the Houston area is now in its sixth week of steady decline, a welcome reversal of the virus’ alarming surge in June and July.

The headcount of COVID-19 patients has fallen by half since its mid-July peak in hospitals affiliated with the seven systems based in the Texas Medical Center. And the number of intensive care patients at those facilities has dropped by a third.

The subsiding wave has merely shifted civic leaders’ concerns, however — and not only because hospital headcounts, new cases, and other metrics remain well above their levels before the spike.

Worried that Houstonians will invite another crisis by concluding it is safe to attend cookouts or crowd onto restaurant patios, public officials and medical leaders are stressing that the best measures of success are not empty intensive care beds but an absence of widespread infections.

“I do worry about people listening to this news and taking it the wrong way, saying, ‘Whew that’s over, now let’s go back to life as normal,’” said Dr. Esmaeil Porsa, CEO of Harris Health, the county’s public hospital district. “This is not the time.”

[…]

In every case, these metrics suggest the Houston region remains well short of containing the virus. The testing positivity rate, for instance, is about 15 percent in the city and county, and 10 percent among TMC institutions.

What about case counts? Harris County over the last week has averaged more than two and a half times as many daily cases as the 400 it would take to step down from Hidalgo’s top threat level. And the nine-county Houston region is averaging almost nine times as many new daily cases as the TMC goal of 200.

Another of Hidalgo’s metrics calls for the share of intensive care patients who have COVID-19 to not exceed 15 percent; the share of ICU patients in the county who have COVID-19 remains more than double that.

We’re headed in the right direction, but we’ve still got a long way to go. Stay home. Maintain social distancing. Wear a mask. Wash your hands.

And while case numbers may be coming down, fatality numbers are higher than we’ve counted.

Since the start of the COVID-19 pandemic in Texas, the state’s death toll from all causes has soared by thousands above historical averages — a sobering spike that experts say reveals the true toll of the disease.

Between the beginning of the local pandemic and the end of July, 95,000 deaths were reported in Texas, according to U.S. Centers for Disease Control data. Based on historical mortality records and predictive modeling, government epidemiologists would have expected to see about 82,500 deaths during that time.

The CDC attributed more than 7,100 deaths to COVID-19, but that leaves roughly 5,500 more than expected and with no identified tie to the pandemic. The CDC’s chief of mortality, Dr. Bob Anderson, said these “excess deaths” are likely from a range of pandemic-related problems, including misclassifications because doctors did not initially understand the many ways that COVID-19 affects the circulatory system and results in a stroke or a heart attack.

“It can cause all sorts of havoc in the body,” he said.

The CDC data offers an opaque but important estimate of how deadly the virus has been in Texas, which suffered from testing shortages for weeks as COVID-19 case counts climbed.

“It has shocked me to see people think that there’s overcounts of the COVID deaths, because I can’t even imagine that that’d be the case,” said Mark Hayward, a professor at the University of Texas who studies mortality trends. “The undercount is so dramatic.”

And there is a clear racial disparity in the undercounts. Between March and the end of July, Texas recorded more than 21,000 deaths of Latinos — more than 5,000 higher than epidemiologists predicted. Of those, about 2,100 were attributed to COVID-19. That leaves more than 3,000 deaths in excess of the expected number, many of them in border counties that lack resources for testing.

This is a phenomenon we’ve seen literally around the world. We’ve certainly known that it’s happening in Texas. The expert opinion is that we’ve already passed 200K deaths nationally, or about 25% more than the official count. If you could read one of the names of those 200K dead Americans every second, it would take you over 55 hours, nonstop, to read them all. Think about that for a minute. Or for 55 hours.

Also, too, we still suck at testing.

After plummeting for days, the number of COVID-19 tests reported in Texas suddenly jumped by 124,693 on Thursday, which state health officials said was a result of coding errors and a system upgrade.

Backlogs at a hospital lab and a commercial lab accounted for most of the tests, which could not be added to the state’s official tally until the coding errors had been fixed, said Lara Anton, spokesperson for the Texas Department of State Health Services.

Of the 124,000 tests reported on Thursday, approximately 95,000 were from a lab that served several hospitals, Anton said, adding that the lab sent files containing an error in one of the data fields, which DSHS’ electronic system could not read.

DSHS doesn’t know when the tests were actually conducted and is working with local health departments to find out, she said.

[…]

Whether because of human error, shifting benchmarks or bureaucratic changes, it’s not the first time that Texas officials have corrected their data since the beginning of the pandemic. Almost every major data point has come with caveats, sometimes blurring for days the big picture of the pandemic in Texas.

It is what it is. I don’t know what else to say.

Finally, the coin shortage is real, y’all.

Some retailers have started posting signs notifying customers that they might not be able to provide exact change for their purchases, and instead ask for them to pay with a credit or debit card or exact payment.

“It’s not like coins are not there,” said Venky Shankar, professor and director of research at the Center for Retailing Studies in Texas A&M University’s Mays Business School. The coins are just being used less as business has slowed and more people stay home.

Another hurdle for coin usage, Shankar said, is the fear that money could carry the novel coronavirus, even though experts don’t know definitively whether cash actually poses a threat.

In order to keep coins circulating, the U.S. Mint has asked people to pay with exact change. “We ask that the American public start spending their coins, depositing them, or exchanging them for currency at financial institutions or taking them to a coin redemption kiosk,” the mint said in a news release. A new task force — the U.S. Coin Task Force — has also been charged with determining how to reinvigorate the supply chain.

[…]

According to Shankar, roughly 45 to 50 percent of sales in smaller stores — places such as convenience stores — are made in cash. But big grocers such as H-E-B, Kroger and Walmart have also faced a shortage of coins.

In response to the shortage, some retailers and restaurants have started to pay or reward customers for their coins.

The U.S. Mint has also increased production from 1.2 billion coins in June to 1.35 billion coins per month for the rest of 2020, according to a Statista review.

But that doesn’t solve everything.

“That still will not unlock the coins that are already in the drawers and the banks,” Shankar said.

Laundromats, which rely heavily on coins to function, are among the businesses directly impacted by the coin shortage.

Yeah, that would suck if no one has any damn quarters. This is a problem all over, and offhand I have no idea what to do about it. I normally like paying for things in cash, but have barely used any since March. This is a teeny tiny reason for saying this, but we live in very strange times.

Hemp lawsuit

This ought to be interesting.

New rules prohibiting the retail sale and distribution of “smokable” hemp products are unconstitutional, companies argue in a lawsuit filed Wednesday in Travis County.

When Texas legalized hemp last year, the legislation explicitly outlawed manufacturing and processing hemp products meant to be smoked. But rules released Sunday defining the state’s hemp program also banned the sale of these products.

That cut off a major source of income for many small businesses that sell hemp in Texas.

[…]

The lawsuit argues the ban of manufacturing and processing smokable products enacted as part of the law is unconstitutional and that the ban on distributing and selling these products is not valid.

Jax Finkel, executive director of the Texas Chapter of the National Organization for the Reform of Marijuana Laws, said banning the sale of smokable products goes beyond the intent of the bill.

You can see a copy of the lawsuit here. There’s a more detailed story here.

In a lawsuit filed in Travis County District Court on Wednesday, the companies are asking a judge to declare the ban unconstitutional and allow hemp products intended for smoking or vaping to be produced and sold legally across the state.

“At a time when the Texas economy is reeling from the fiscal impact of COVID-19, it is unfortunate that the State chose to foreclose such a large economic opportunity for our state and instead chose to force long-standing Texas businesses and jobs across the border to neighboring states, such as Oklahoma,” said attorney Chelsie Spencer, counsel for lead plaintiff Crown Distributing LLC.

“Crown Distributing, which manufactures the popular Wild Hemp brand of smokable products, stands to lose $59.6 million in revenue over the next five years if the bans are upheld,” Spencer told Marijuana Moment in an email. “The state of Texas stands to lose $2.9 million in sales tax revenue alone.”

Texas legalized hemp in 2019, in large part to capture a piece of an industry that is booming following the federal legalization of the crop through the 2018 Farm Bill. Hemp, a category of cannabis that contains less than 0.3 percent THC, has a variety of uses: Its seeds are a nutritious food source, its fibrous stalks can be made into textiles or building materials and its flowers can produce a variety of cannabinoids, most notably cannabidiol (CBD).

Texas’s hemp law as passed by the legislature specifically prohibited the manufacture of hemp products intended for smoking or vaping, though it left open the door for selling products made out of state. But a year later, regulators at the Texas Department of State Health Services (DSHS) issued rules extending that ban to forbid the retail sale of any smokable hemp products. That restriction took effect on Sunday.

Plaintiffs in the lawsuit argue that both those provisions should be overturned. The state legislature’s ban on processing and manufacturing smokable products violated the state constitution’s protection of economic freedom, they say, while DSHS lacked the authority to extend lawmakers’ ban to include retail sales.

“DSHS characterizes banning distribution and retail as ‘a logical extension’ of banning manufacturing,” the lawsuit says. “But even if this were true (it is not), agencies have no authority to enact rules that they deem to be a ‘logical extension’ of law.”

[…]

“If allowed to move forward, these bans on smokable hemp products will shutter businesses across the state, resulting in a loss of jobs and tax revenue,” the companies said in their complaint. “They impede the economic liberty of Texas businesses, pose an existential threat to Texas hemp manufacturers, farmers, and retailers, and are sure to stifle growth of a budding Texas industry.”

As for the ban on producing and manufacturing smokable hemp products, the companies say it violates the state constitution’s protections against arbitrary economic restrictions.

“There is no plausible law enforcement benefit from banning the Texas manufacture and processing of smokable hemp products,” the lawsuit argues. “Imposing an arbitrary constraint here is particularly perverse because the law does not ban the use or consumption of smokable hemp products. As such, Texas consumers will simply buy smokable products made out-of-state.”

“Stated differently,” it continues, “if Texas had banned the processing and manufacture of cheese in Texas, Texans wouldn’t stop eating cheese.”

See here for more on the hemp legalization bill (HB1325), which has also had the effect of making it a lot harder to prosecute marijuana cases. I’d be very interested to hear what a lawyer thinks about this complaint. I’ll say that the bits quoted here sound a lot like political arguments, which were made during the discussion of the bill. Don’t get me wrong, I largely agree with those arguments, but that doesn’t mean they’ll have any purchase in a courtroom. Still, this could be interesting, and it may help push the broader legalization argument forward. Perhaps we’ll get another incremental bill this session; we are for sure not getting anything more ambitious than that as long as Dan Patrick is Lt. Governor. But there’s a lot of room for small steps, and who knows, maybe this will end up being a big one. I wouldn’t count on it, but you never know. Reform Austin and the Hemp Industry Daily have more.

Another lawsuit against Abbott over emergency orders

This one is a bit more serious due to the lack of Hotze and Woodfill, but it’s still not a great way to have the debate about this issue.

Five Republican Texas lawmakers are suing Gov. Greg Abbott over the state’s $295 million COVID-19 contact tracing contract to a small, little-known company, alleging the agreement is unconstitutional because it wasn’t competitively bid and because the funds should have been appropriated by the Legislature in a special session.

In the Travis Country district court suit filed Monday, State Reps. Mike Lang, Kyle Biederman, William Zedler, Steve Toth and state Sen. Bob Hall named as defendants Abbott, the Texas Department of State Health Services and the company awarded the contract, the Frisco-based MTX Group.

Abbott and Attorney General Ken Paxton have defended the contract. Abbott did not immediately respond to a request for comment.

The lawmakers are seeking a court order voiding the contract for lack of statutory authorization and deeming unconstitutional the governor’s application of the Texas Disaster Act of 1975, which gives him broad powers in the case of an emergency, in granting the contract.

“The Texas Constitution requires a separation of powers, and that separation leaves policy-making decisions with the Texas Legislature,” the lawsuit states. “These decisions are not changed by pandemics.”

Abbott has declined to convene a special session since March when the coronavirus pandemic began, instead leaning on his emergency powers to issue a series of sweeping executive orders governing what businesses can open, where people can gather in public, and mandating safety measures including wearing face coverings in public.

While the law has been used by governors for years, the time span of the coronavirus-related orders is unprecedented and raises questions about the durability of that legal justification.

As the story notes, the Supreme Court just rejected several Hotze lawsuits relating to executive emergency powers, saying he lacked standing. I don’t know if that is likely to be an issue in this case or not. I still agree with the basic premise that we need to have a robust debate about the parameters of the Texas Disaster Act, including when the Governor should be compelled to call a special session so that the Lege can be involved in the decision-making process. I also still think that this is a lousy way to have that debate, and while these five legislators have more gravitas than Hotze, that’s a low bar to clear. To put it another way, the anti-face mask and quarantine lobby still isn’t sending their best.

There’s no doubt that the contact tracng deal was a boondoggle, and I welcome all scrutiny on it. And I have to admit, as queasy as I am with settling these big questions about emergency powers by litigation, there isn’t much legislators can do on their own, given that they’re not in session and can’t be in session before January unless Abbott calls them into a session. I’m not sure what the right process for this should have been, given the speed and urgency of the crisis. The Lege very much needs to address these matters in the spring, but I’m leery of making any drastic changes to the status quo before then. In some ways, this is the best argument I’ve seen against our tradition of having a Legislature that only meets every two years. Some things just can’t wait, and we shouldn’t have to depend on the judgment of the Governor to fill in the gaps. I hope some of the brighter lights in our Legislature are thinking about all this. The Trib has more.

We still suck at COVID data

I’m sure none of this is important.

The government’s official data on the coronavirus outbreak is startling: More than 4.6 million cases in the U.S. More than 440,000 in Texas. More than 70,000 in Harris County.

But those numbers don’t include all positive COVID-19 patients.

Texas, unlike 27 other states, excludes the results of increasingly popular, rapid COVID-19 tests from the numbers it reports publicly — obscuring the scope of the pandemic, records and interviews show. The antigen tests are used in doctor’s offices, hospitals and stand-alone clinics and deliver results in less than 30 minutes.

But conflicting guidance from the Texas Department of State Health Services created confusion among local health departments about what test results to report. A reliance on faxed test results has created a paper backlog that makes it impossible for the state to do its own tally.

And while there is no way to independently estimate the scope of the undercount, based on the 11 Texas counties that publish antigen tests results separately of their own accord, the state’s tally is short by at least tens of thousands of cases — but likely far more, a Houston Chronicle analysis found.

And the undercount is about to get worse. The federal government is rolling out a program to use thousands of antigen tests in nursing homes across the country — including Texas.

State Rep. Gina Hinojosa, D-Austin, who serves as vice-chair of the House committee that oversees the state’s public health agencies, said the lack of reliable data is hindering the overall COVID-19 response effort in Texas.

“The only way people will be inspired to act right without government mandates is if they have the information they need to make smart choices,” Hinojosa told the Chronicle. “And that has been just impossible to come by.”

The problem, apparently, is that the state considers a positive antigen test to be a “probable” positive for COVID-19, not a definite positive. I mean, I figure a couple of data geeks could work out a decent solution for this in less than a day’s work, so color me baffled by the confusion here. And if you’re confused for other reasons, please note that antigen tests are different from antibody tests, which determine if you have had COVID-19 in the past, and thus should be in a separate category. It would be nice if we could get this all straightened out. The Trib has more.