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Texas Department of State Health Services

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.

So we really were undercounting the COVID-19 death rate

Can’t say I’m surprised.

After months of undercounting coronavirus deaths, Texas’ formal tally of COVID-19 fatalities grew by more than 600 on Monday after state health officials changed their method of reporting.

The revised count indicates that more than 12% of the state’s death tally was previously unreported by state health officials before Monday.

The Texas Department of State Health Services is now counting deaths marked on death certificates as caused by COVID-19. Previously, the state relied on local and regional public health departments to verify and report deaths.

Public health experts have said for months that the state’s official death toll is an undercount. State health officials said Monday that the policy change would improve the accuracy and timeliness of their data.

Texas law requires death certificates to be filed within 10 days.

“This method does not include deaths of people who had COVID-19 but died of an unrelated cause,” the Texas Department of State Health Services said in a news release.

[…]

After the number of infections in Texas soared to new highs in June and early July, the rate of deaths in Texas has been accelerating. It took 53 days to get from the first death to 1,000 deaths and 39 days to get from 1,000 to 2,000 deaths. On July 10, the state surpassed 3,000 deaths — 24 days after 2,000 deaths were reported. And it took only 10 more days for Texas to reach 4,000 deaths.

While Texas continues to report daily deaths in the triple digits, the number of new daily cases seem to be stabilizing. In the past week alone, state data appears to show new daily infections leveling off, albeit at nearly record highs.

The state recorded its largest number of daily new cases July 15, at 10,791. On Sunday, that number was 5,810.

I’m not sure I fully understand what was changed, so I don’t have much to say about this. I think one can argue that we’re still undercounting the true number of COVID-19 deaths, because it has been known for a long time that some people who almost certainly had the virus die at home without ever having been tested. More broadly, people have died as a result of delaying or skipping medical care for other issues because they feared catching COVID from going to the doctor’s office or emergency room. Maybe those aren’t “official” deaths, but they are deaths that wouldn’t have happened in a non-pandemic situation. I suspect we won’t really understand the scope until some years from now when academics can do a deeper analysis of all the data. In the meantime, this is what we have. The Chron has more.

The contact tracing debacle

Let us never forget about this.

Just as coronavirus infections began rising a few weeks ago in Texas, contract workers hired by the state to track down exposed Texans were spending hours doing little or no work, received confusing or erroneous instructions and often could not give people the advice they expected, interviews and records indicate.

Health authorities around Texas also say they are running into technical snags with new contact tracing software the state has deployed, known as Texas Health Trace, saying it isn’t ready for widespread use in their counties.

The chaotic beginning and technical glitches — combined with exploding case counts and widespread testing delays — have undermined the goals of boosting COVID-19 monitoring statewide and the state’s massive deal for a privatized contact tracing workforce.

“I know that a lot of local health departments are still trying to figure out how to utilize that contract and some have decided to do the work on their own,” said David Lakey, chief medical officer at the University of Texas System and former commissioner of the Department of State Health Services (DSHS). “There is concern with local health department individuals I’ve talked to related to how they are going to benefit related to this large investment from the state.”

DSHS said problems identified by the Houston Chronicle have since been fixed and that “every week” more counties are using its software.

Gov. Greg Abbott’s office said months ago that robust contact tracing capacity would help Texas “box in” the coronavirus. But after the state reopened its economy, infections, hospitalizations and deaths skyrocketed, making it impossible for many health departments to keep up with contact tracing.

“When you kind of jump the gun a little bit and open too soon, and you skip the processes that need to be in place, this kind of thing happens,” Harris County Judge Lina Hidalgo said. “You might have the most successfully designed contact tracing program or you may not, but honestly it’s not gonna make a difference because you’re setting yourself up to fail.”

At the state level, Texas moved to ramp up and modernize contact tracing in May, when the Texas Health and Human Services Commission quietly awarded a $295 million contact tracing deal to little-known MTX Group, a tech startup that has a headquarters in North Texas. Abbott’s office has staunchly defended the emergency expenditure, but it’s been controversial from the get-go.

The bid for the work, which was never publicly posted, was awarded to MTX without input from top state leaders, and more than a dozen legislators subsequently called for the state to cancel the contract.

More recently, four people who performed contact tracing work for MTX or one of its partners raised questions about the tech company’s performance. They spoke to the Chronicle on condition of anonymity because they weren’t authorized to speak on the record about their employment. Three said they fielded only a handful of phone calls during several weeks in May and June.

You can read on for details of the various failures of the program as implemented, and you can see here for more on Texas Health Trace. My point is that having a certain number of contact tracers in place, a number that was never met, was one of the four conditions of reopening set by Greg Abbott. The real failure here, as has been the case with everything else, was the complete lack of effort to meet those metrics that were set out. The failure to do so led directly to the situation we’re in now. The fact that MTX was given a no-bid contract on Abbott’s say-so and no one else’s input is a separate issue, one that deserves a fuller exploration, but not necessarily a main cause of the failure. It’s possible to imagine a scenario in which a legitimate and fully-resourced company could have gotten this contract in a similar fashion and done a better job with it. The process would have still been a problem, but at least the result was okay. Here we had both a bad process and a bad outcome, and both of those need to be investigated. They also need to be hung around Greg Abbott’s neck from now until November of 2022.

Is this convention really necessary?

Seriously. I know they don’t care about anyone else, but maybe the state GOP might think about the health and well-being of their own people?

As the coronavirus pandemic engulfs Texas’ metropolitan areas, Republican Gov. Greg Abbott has left the door open for massive indoor gatherings. And organizers are moving forward with some big ones, including the Texas Republican party’s upcoming convention in Houston.

Harris County, where Houston is located, has the highest number of coronavirus cases and deaths in the state, but the Texas GOP plans to press forward with plans to hold an in-person convention from July 16-18 in the city’s George R. Brown Convention Center.

“All systems are go, folks. This is happening,” Kyle Whatley, the party’s executive director, said Tuesday during a tele-town hall, noting the convention program is already being printed.

On Tuesday, Abbott granted local officials the power to restrict outdoor gatherings of more than 100 people, but made no mention of indoor gatherings. The Texas GOP convention is expected to draw about 6,000 attendees, roughly half of what it would expect for such a convention in normal times, according to Whatley. The party’s website brands its annual convention as the “largest political gathering in the free world.”

Whatley said registrations are “increasing exponentially” as the convention nears.

David Lakey, the former commissioner of the Texas Department of State Health Services, said he believes large indoor gatherings of more than 100 people are not advisable at this time.

“I think, right now, I wouldn’t hold a group larger than 100 individuals,” he said. “I think people need to be very cautious about making — especially in the month of July — any plans for a big conference.”

The party does not plan to require masks at the convention, though chairman James Dickey acknowledged Tuesday that Harris County is currently under an order mandating that businesses require customers to wear masks.

“The Republican Party isn’t considered a commercial entity so they themselves are not required to comply with the mask order,” said Melissa Arredondo, a spokesperson for the office of Harris County Judge Lina Hidalgo, who issued the mask order.

That order expires Tuesday, and Dickey said the party will “revisit” the mask issue during another tele-town hall next month before the convention.

Maybe read the story of Bill Baker, and then rethink this? Just a suggestion. And it truly is ridiculous to be allowed to ban outdoor gatherings of more than 100 people while being forced to allow a much riskier indoor event of thousands of people. I’m sure someone pointed out to Abbott that if he did the sensible thing and allowed all gatherings of large sizes to be banned by local officials, the GOP convention would be immediately canceled. It’s still ridiculous.

And look, if this were only a bunch of Republican activists putting themselves at risk, I’d shrug my shoulders and let them enjoy their “freedom”, for whatever it was worth. But of course, they’re not just putting their own health and safety on the line, they’re endangering everyone who will be working at the convention as well. Those folks deserve better.

The situation has created what union leaders say is a potentially perilous situation for workers at the Hilton Americas-Houston hotel, which is connected to the convention center and expects to see an uptick in guests during the convention. Officials from Unite Here Local 23, the union that represents hotel and other hospitality workers, say health insurance benefits are set to expire for Hilton workers at the end of the month, since many of them were laid off at the beginning of the coronavirus pandemic, leaving them short of the hours needed to qualify for coverage.

Houston First Corp., the city’s convention arm, owns the Hilton Americas-Houston and operates the George R. Brown Convention Center.

Houston First Chairman David Mincberg disputed the union’s claim, saying in a statement to the Chronicle that all Houston First and Hilton employees “will have health insurance coverage (except those who have opted out) while working at the George R. Brown Convention Center or the Hilton” during the convention. Mincberg also said Houston First officials “do not anticipate any part-time workers being utilized.”

Hilton employees are set to lose their health coverage at the end of July if they do not work enough hours in June to qualify for coverage, while those laid off earlier will lose it by June 30. Union officials said nearly 450 employees have been laid off by the Hilton since February, accounting for about 95 percent of the hotel’s employees.

Bo Delp, senior political organizer for Unite Here Local 23, questioned how the Hilton could adequately staff the convention if only 5 percent of its employees are set to qualify for health coverage through the end of July.

“Houston First has made a decision that during a global pandemic, it is going to continue to host events,” Delp said. “The minute they made that decision, from our perspective, they had a moral and public health obligation to make sure that the workers who are coming in as a result of their decision to host events, that they are healthy and safe.”

Mincberg said Houston First lacks the ability to cancel the event or require convention guests to wear masks, even if conditions worsen before mid-July.

“(Houston First) does not have the authority to require safety measures, unless included in the original license agreement. Since this agreement was issued prior to the pandemic, no such provision was included,” Mincberg said.

Catherine Troisi, an epidemiologist at UTHealth School of Public Health in Houston, urged Houston First officials to provide health coverage for hospitality workers and “institute preventive activities” to limit the spread of COVID-19 during large gatherings at the convention center.

“We know that closed spaces, crowded conditions, close contact, and duration of contact all enhance transmission of this virus,” Troisi wrote in a letter to Mincberg on Tuesday. “This convention space includes all of these risk factors and particularly without mandatory masking, transmission of the virus is almost inevitable, both to convention attendees and to hospitality employees.”

Every employee who works this dumb convention should have full health care coverage. Whatever it takes to give that to them, make it happen. And in the future, all contracts for conventions in Houston facilities should include clauses about pandemics and requirements for face masks and following county health mandates. The very least we can do from this experience is learn from it.

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

We’re getting there.

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

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

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

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

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

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

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

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

It’s bad, y’all.

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

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

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

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

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

Stay home.

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

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

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

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

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

UPDATE: Oh, the irony.

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

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

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

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

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

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

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

Whistling past the ICU

Clap louder!

Gov. Greg Abbott and top Texas health officials on Tuesday responded to growing alarm over hospitals now swelling with coronavirus patients, assuring there is still plenty of space available even as some facilities have neared or surpassed capacity.

Speaking on yet another day of record high hospitalizations from the pandemic, Abbott said he is confident the state can continue reopening while controlling the spread of new infections.

“As we begin to open up Texas and Texans return to their jobs, we remain laser-focused on maintaining abundant hospital capacity,” said Abbott, a Republican. “The best way to contain the spread of this virus is by all Texans working together and following simple safety precautions.”

On Tuesday, the Department of State Health Services reported just over 2,500 COVID-19 patients in Texas hospitals, the highest single-day total since the pandemic began and nearly 67 percent more than on Memorial Day in late May. State and local leaders have pointed to the holiday weekend as one likely cause for the increase.

Statewide, there are still thousands of hospital beds and ventilators available. But in some of the largest cities, including San Antonio and Houston, the surge is pushing new limits. In Harris County, some hospitals said late last week that their intensive care units were near or above capacity.

Bill McKeon, CEO of the Texas Medical Center, said their number of COVID-19 patients has nearly doubled from its previous peak in late April. Many of the patients admitted now are younger and generally healthier, but are still susceptible to serious illness or death from the disease.

“If it continues to grow at this rate, we’re going to be in real trouble,” McKeon said of the admissions. He added that while it may not be feasible to reimpose lockdowns or other restrictions, state leaders should consider slowing the reopening if the uptick continues.

The official death count is past 2,000 now, though everyone knows that’s an undercount. On a per capita basis that’s still pretty low, but we’re doing our best to catch up. The idea that we’re “controlling the spread” in any fashion is laughable, except there’s nothing funny about what’s happening. And then we get this:

Abbott remained unwilling Tuesday to allow local officials to enforce their own mask ordinances, even as he acknowledged that many Texans are not wearing them. He instead accused Democratic county judges of not having done enough to punish businesses that fail to comply with other protocols, such as limits on public gatherings.

While they have the authority, Abbott said, many “haven’t lifted a finger.”

Hey, remember when Greg Abbott cravenly flip-flopped on consequences for not following his own executive orders? Good times, good times. What would you like the county judges to use, harsh language? Let’s not forget who’s in charge here.

But local officials are still trying, at least:

The mayors of nine of Texas’ biggest cities urged Gov. Greg Abbott in a letter Tuesday to grant them the “authority to set rules and regulations” mandating face masks during the coronavirus pandemic.

As COVID-19 cases and hospitalizations continue to climb in Texas, an executive order from Abbott bans local governments from imposing fines or criminal penalties on people who don’t wear masks in public. The mayors wrote that many people in their cities continue to refuse to wear face masks and that “a one-size-fits-all approach is not the best option” when it comes to regulating the issue.

The letter is signed by Houston Mayor Sylvester Turner, San Antonio Mayor Ron Nirenberg, Austin Mayor Steve Adler, Dallas Mayor Eric Johnson, Fort Worth Mayor Betsy Price, El Paso Mayor Dee Margo, Arlington Mayor Jeff Williams, Plano Mayor Harry LaRosiliere and Grand Prairie Mayor Ron Jensen.

The letter asks Abbott to consider allowing each city’s local officials to decide whether to require the use of a face covering in order to prevent the spread of the virus.

Mayor Turner’s press release is here, and a copy of the letter sent to Abbott is here. There was no response as of Tuesday afternoon.

Finally, let’s not forget that even as businesses may want to reopen, coronavirus may not let them. It’s almost as if an unchecked pandemic is a hindrance to having your economy run at full capacity. But don’t worry, Greg Abbott has everything under control. Now keep clapping!

We keep hitting the wrong marks

Up, up, and up.

For the second day in a row, Texas has reported a record number of patients hospitalized with the new coronavirus, a metric Gov. Greg Abbott has said he’s watching as businesses continue reopening and limits on their operations are loosened.

Data released Tuesday by the Texas Department of State Health Services shows 2,056 people were hospitalized with COVID-19, up from 1,935 the day before. The previous high was May 5, when 1,888 people were hospitalized.

The figures come a little more than a month since Abbott’s statewide stay-at-home order ended and he began a phased reopening of businesses. It also comes about two weeks after Memorial Day.

[…]

“I’m concerned but not yet alarmed,” Abbott told a North Texas television station. “I look at Amarillo that was a hot spot zone a couple of weeks ago, where they had a lot of concerns. We had surge response teams that addressed it, and now their hospitalizations are going down.”

Texas has 15,400 available hospital beds and 1,700 available ICU beds, the data shows. There are 5,900 ventilators available. The number of available beds is seen as a key gauge for the state’s ability to handle a potential surge in coronavirus cases, and Abbott has said the hospitalization rate — the proportion of infected Texans who are requiring hospitalization — is a benchmark he’s closely monitoring. He cited it as an encouraging metric as the state’s stay-at-home order expired at the end of April.

In Houston, Dallas and other areas that have seen increased hospitalizations, “we need to drill down and find out exactly why that is,” Abbott said.

Yeah, I’m closely monitoring the hospitalization rate, too. We’re now at three straight days of record numbers there, for those of you playing along at home. It’s happening locally, and it’s mostly been happening since Memorial Day. I’m going to keep asking the same question I have every time I do one of these posts: What’s our plan for when we start getting into the “dangerously full” zone for hospitals? If it turns out to be localized rather than everywhere in the state, will Greg Abbott let local leaders have more discretion to take action as they had back in March? I really really hope it doesn’t come to that, but hope seems to be all we’ve got.

UPDATE: From the Trib: “Texas reports largest single-day increase in coronavirus cases”. Insert shrug emoji here.

That’s not how you test

Oops.

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

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

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

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

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

[…]

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

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

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

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

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

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

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

More reopening

Onward we go, whether wise or not.

Gov. Greg Abbott on Monday announced his next wave of reopenings designed to restart the Texas economy during the coronavirus pandemic, saying child care facilities can reopen immediately, bars can open Friday with limited capacity and sporting events can return without fans at the end of the month.

Abbott also said he would permit restaurants to operate at 50% capacity starting Friday, up from 25% that’s allowed now.

At the same time, Abbott exempted two hotspot regions — Amarillo and El Paso — from his latest decisions, saying they would need to wait a week — until May 29 — while the state’s surge response teams work to contain outbreaks in each area.

Abbott’s news conference came 18 days after he began a phased reopening of the state, starting with letting restaurants, stores, movie theaters and malls open up at 25% capacity. He then allowed barbershops and salons to reopen May 8 under certain restrictions. Monday was the first day gyms were allowed to open up, also under restrictions.

Previously, child care was only available to workers deemed essential by the state. Abbott’s announcement Monday allows child care centers to reopen to help all workers returning to their jobs.

In addition to bars, Abbott is letting a host of other establishments reopen Friday, including bowling alleys, bingo halls, skating rinks, rodeos, zoos and aquariums. In the lead-up to Monday, however, the fate of bars had drawn the most attention, especially after Abbott began allowing restaurants to reopen May 1. All the businesses opening Friday will only be allowed to operate at 25% capacity.

For bars that reopen Friday, the state is recommending that customers remain seated at tables of no more than six people, among other restrictions. Dancing is discouraged.

Insert Baptist joke here. On the one hand, the daily case numbers keep rising, with no clear indication that we were approaching a peak even before we started loosening things up, and without achieving the Abbott-stated benchmark of 30,000 tests per day. It’s not that we’re reopening per se, it’s that Abbott himself laid out conditions and requirements and penalties for people who failed to comply, then dropped it all like a hot rock the minute some grifter hairstylist in Dallas threw a hissy fit. It just doesn’t inspire confidence that Abbott has any idea what he’s doing or any plan to retreat if things start to get worse. That said, the rate of growth in the state is fairly slow, hospital capacity is in good shape – both of these are no doubt helped by the solid results in Harris County, for which Abbott owes Lina Hidalgo a big thank you – and to his credit Abbott paid attention to the places that needed and asked to be excluded from this round of reopenings.

The next round of reopenings will come May 31, when Abbott allow permit summer youth camps to reopen — as well as let certain professional sports to resume without spectators. The sports include basketball, baseball, car racing, football, golf, softball and tennis. Leagues will first have to apply to — and receive approval from — the Texas Department of State Health Services.

[…]

Notably, Monday marked the first time that Abbott singled out specific regions as not ready to take part in the latest reopenings.

Amarillo has been a hotspot due to outbreaks at its meatpacking plants, and earlier this month, the state dispatched one of its Surge Response Teams to the city to try to get things under control. Of the 1,801 new cases that Texas reported Saturday, over 700 were linked to the Amarillo meatpacking plants, according to Abbott’s office.

In El Paso, the situation has deteriorated enough that the county judge, Ricardo Samaniego, and other local officials asked Abbott last week to exempt the county from the next reopenings until the county sees a two-week downward trend in the number of positive cases or positive test rate. Abbott said Monday that El Paso’s hospital capacity is “too close for comfort at this particular time.”

The one-week delay “will give those communities and our surge team response the time needed to slow the spread and maintain hospital capacity,” Abbott said. “It will ensure those communities safely move into phase 2.”

The counties subject to the delay are El Paso, Randall, Potter, Moore and Deaf Smith. The latter four are all in the Amarillo region.

I have my doubts that the Abbott Strike Force will make any difference in these places, unless they find the will to shut down the meatpacking plants that have been such hotspots, but at least he’s not ignoring reality, unlike some other state officials I could name. He’s still wishy-washy, and in the end if this works out reasonably well I’ll believe it’s because he was more lucky than smart, but it could be worse. In this state, that’s often the best you can hope for. The Chron, the Press, the Current, the Rivard Report, and the Dallas Observer have more.

More on coronavirus and meat processing

From the Trib:

To understand powerlessness in a pandemic, trace a northbound path from Amarillo up State Highway 87. Not too far shy of the border where Texas meets Oklahoma lies Moore County.

There are few easy ways to make a living in this country of feedlots and dryland cotton, but one of the hardest is at the JBS Beef meatpacking plant. Just about everything looks small on these vast flatlands until you get right up on it, but the 125-acre plant in the tiny town of Cactus is massive from any vantage point.

The steady billow of gray smoke from the plant’s stacks tells you it is still running full tilt. With the coronavirus pandemic gripping the world, it’s considered essential to keep thousands of cattle running through the kill floor each day, headed for dinner tables across America.

Meat and poultry plants nationwide have emerged as incubators for coronavirus spread. More than a dozen have been forced to shut down temporarily as the number of cases and deaths tied to those facilities rose; others have scrambled to ramp up health and safety precautions in facilities where meatpackers often must work shoulder to shoulder.

State health investigators are tracking 159 coronavirus infections tied to the Cactus plant, including one death associated with the outbreak, and Moore County now has the highest reported infection rate in Texas. Yet about 3,000 workers, mostly immigrants from Mexico and Guatemala and refugees from Asia and Africa, still report there each day.

Meatpacking has always been brutal and dangerous work, but it pays relatively well. JBS jobs have drawn generations of immigrants to this rural community, so many that Hispanics make up more than half of Moore County’s nearly 22,000 residents, and one quarter of the population is immigrants.

But the people who prop up life here, the ones now getting sick or working in fear wondering when they will, have little power over what the coronavirus is doing to their lives, because they have little power here at all.

From the Observer:

Officials at Tyson’s poultry processing plant in Shelby County may have waited weeks to tell workers that an employee had tested positive for COVID-19, preventing other workers from taking action to prevent the spread of the virus inside the facility, plant employees told the Observer last week. The company waited even longer to implement rudimentary safeguards (such as breathing masks and plastic screens to separate workstations) as more workers fell ill, were hospitalized, and died, they say.

[…]

The Observer has changed Bennett’s name, as well as the two other employees named in this story, after employees expressed concern that Tyson might retaliate against them for speaking to a reporter. The story also omits some details of employees’ positions within the plant and their medical histories to make them less identifiable. The extent to which the Tyson outbreak has contributed to COVID cases in this rural region is still unclear, partially because of a lack of reliable state data on infection rates and testing. It is clear, however, that some workers feel as if Tyson put profits over worker safety as the virus spread through the facility this month. If the company had distributed protective equipment earlier, “it probably wouldn’t be as bad as it is now,” Bennett says.

The employees say that approximately three weeks ago, a plant supervisor told workers that at least one employee had tested positive. But they shouldn’t worry, the supervisor reportedly said—the case had occurred two weeks earlier, so other workers likely wouldn’t be threatened. The announcement hit the workers like a bombshell. “I don’t think it was fair to us as employees the way they waited until 14 days later to tell us,” says Denise Richardson, who has not contracted the virus. “If you’ve got paperwork confirming that someone has it, you let everybody know and give us all an opportunity to take proper precautions.” At the time, the company had just recently begun to start screening workers by checking their temperature, and masks had not been widely distributed to employees, Richardson says.

By the time Tyson alerted employees to the danger, the virus already appeared to be spreading. Bennett, after days of “feeling sicker and sicker, weaker and weaker” at work, was hospitalized shortly after the announcement. Bobby Dawson, another Tyson employee, tested positive for COVID-19 about the same time as Bennett. He says he informed plant supervisors about the positive test result the same day he learned of it. Dawson criticized the company for not telling him about the situation sooner, which would have allowed him to take precautionary measures to keep from getting sick, such as taking days off work or wearing protective equipment. “They hid it from us. They didn’t give us a choice to do anything,” Dawson told the Observer. “Their main concern is to get them chickens out, regardless of what their employees are going through. That’s why we all come up sick.”

The conditions of the plant lend themselves to the spread of disease, the workers say. Employees work “elbow to elbow” as they defeather, eviscerate, and debone thousands of birds a day. Even the most innocuous task—such as clocking in for a shift and clocking out at the end of the day—appears to present considerable risk, as hundreds of employees crowd the few functional terminals. “You got so many people trying to clock in at one time you can’t do nothing but catch it,” Richardson says. “We’re packed in there like a bunch of sardines.”

Richardson also notes that many of the plant’s workers cross the border each day from Shelby County’s adjacent parishes in Louisiana, a state that’s been ravaged by the virus. Shelby County shares a border with DeSoto Parish, where at least 180 confirmed cases and 10 deaths have been counted among a population of only 27,000.

See here for the background. These and other meat processing plants will continue to stay open due to federal order. I don’t have anything to add here, just that you should go read both of these stories.

And so reopening begins

I have questions.

Gov. Greg Abbott said Monday that he will let the state’s stay-at-home order expire Thursday as scheduled and allow businesses to begin reopening in phases the next day, the latest ramp-up in his push to restart the Texas economy amid the coronavirus pandemic.

First to open Friday: retail stores, restaurants, movie theaters and malls. But they will only be allowed to operate at 25% capacity. Museums and libraries will also be allowed to open at 25% capacity, but hands-on exhibits must remain closed.

Abbott said a second phase of business reopenings could come as soon as May 18 — as long as the state sees “two weeks of data to confirm no flare-up of COVID-19.” That second phase would allow business to expand their occupancy to 50%, according to the governor.

Abbott made the announcement during a news conference at the Texas Capitol, which he began by saying he would let the stay-at-home order expire because it “has done its job to slow the growth of COVID-19.” While the spread of the virus in Texas has slowed down throughout April, the number of cases is still increasing day to day, and it is unclear if the state has yet seen its peak.

“Now it’s time to set a new course, a course that responsibly opens up business in Texas,” Abbott said, flanked by Lt. Gov. Dan Patrick and Texas House Speaker Dennis Bonnen. “Just as we united as one state to slow COVID-19, we must also come together to begin rebuilding the lives and the livelihoods of our fellow Texans.”

Abbott said his new order “supersedes all local orders” saying those businesses must remain closed. He also said his order overrules any local government that wants to impose a fine or penalty for not wearing a mask — something the latest statewide rules encourage but do not mandate.

Speaking shortly after Abbott in Houston, the city’s mayor, Sylvester Turner, told reporters that Abbott’s new order “pretty much will take these measures, the ability to [issue] stay-at-home orders and things of that nature, out of our hands locally.” He said he hoped Abbott’s plan works but offered a “cautionary note,” pointing out that there is still no vaccine and statistics show the “virus is still here,” even as local measures have slowed it down.

Abbott stressed that his order “gives permission to reopen, not a requirement,” and businesses can stay shuttered if they would like.

At the same time, Abbott said he is holding off on reopening certain businesses for the time, including barbershops, hair salons, bars and gyms. He said he hopes those businesses can open “on or no later than mid-May.”

[…]

Abbott mostly focused Monday on contact tracing, or the practice of tracking down and isolating all the people someone who tested positive for the virus has come into contact with. Abbott said Texas is already in the second phase of its contact tracing plan, adding 1,000 tracers on top of the existing 1,100 and launching a statewide app and call center to improve the process.

Abbott continued to talk of a coming increase in testing and said the state soon would “easily exceed our goal of 25,000 tests per day.” The state has been adding an average about 14,000 tests per day over the past week, according to figures from the Texas Department of State Health Services. Still, the total number of tests done as of Monday — 290,517 — remained about 1% of Texas’ nearly 29 million people.

See here for the background, and here for the plan, such as it is. It’s full of guidelines for various businesses and customers and nursing homes and the like, and short on details about things like how we’re going to achieve the testing goal. If you haven’t yet started wearing a face mask you don’t have to, though you really should and in some places you won’t have a choice regardless of what Abbott says.

I said I have questions, so here are a few:

– How many businesses will consider it worth the bother to reopen at 25% capacity?
– What does “confirm no flare-up of COVID-19” mean? As the story notes, the daily number of cases is continuing to rise. If two weeks from now that is still the case, but the rate of the daily increase hasn’t gone up, is that a success under the Abbott plan?
– What happens if there’s a local “flare up”, like say at another meat processing facility, or just in some random part of the state? If Montgomery County has seen an uptick in cases, do they get to re-impose a shutdown order?
– When should we expect to see that statewide app? Will it require some minimum number of people to download and install it in order to work? What metrics will there be for it – number of app downloads, number of people traced, number of infections mapped out, etc? What happens if we fail to meet those metrics?
– What medical experts advised on this? Because clearly not all medical experts are in agreement with it.

I don’t know the answer to these questions. I doubt Greg Abbott knows the answer to most of them. As I said before, the word that comes to mind for this is “half-baked”. Maybe everything will be fine, maybe we’re just easing up on less-risky behavior, maybe that testing and contact tracing regimen will be more robust than I expect, maybe people will continue to take social distancing seriously enough to keep a lid on things. I hope everything does go well. I’d surely like to start going places and doing things again. I’m just concerned that we barely have a Plan A, let alone a Plan B. What will we do if this doesn’t go the way we hope? The Current, the Press, the Rivard Report, and the Chron have more.

Coronavirus and meat processing

In the Panhandle:

State health officials confirmed Tuesday that they are investigating an outbreak of the new coronavirus at the JBS Beef packing plant in the Texas Panhandle, part of ongoing efforts to monitor major meat processing plants as the pandemic continues to threaten food supply chains.

Earlier this month, the Department of State Health Services conducted an epidemiological investigation in Shelby County that identified a cluster of 14 coronavirus cases and two related deaths that were “in some manner” tied to employees of a Tyson Foods facility.

Now, a department spokeswoman said, an “environmental assessment team” is being sent to Moore County to advise on ways the massive meatpacking plant, which processes a significant portion of the nation’s beef, can curb the spread of COVID-19, the disease caused by the new strain of the coronavirus.

The investigation follows the shuttering of the company’s meat packing plants in other states because of local outbreaks. Moore County, near the Oklahoma border, has one of the highest rates of infection per capita in the state. (Some local leaders attribute it to rapid testing.)

After a call with Tyson Foods officials, the health department asked the company to enact additional protections for employees at its facility near the Louisiana border, including monitoring all individuals entering the facility for both fever and other COVID-19 related symptoms, and to increase its sanitizing as part of the transportation the company provides for workers.

And in East Texas:

The state health department is investigating cases at a Tyson poultry processing plant in Shelby County that may comprise a significant number of the county’s 69 confirmed cases. While meatpackers across the nation have been slammed with high numbers of coronavirus cases, leading to the deaths of workers and facility closures, this represents one of the first known outbreaks of the virus at a plant in Texas.

The Texas Department of State Health Services (DSHS) has offered few details of its investigation into the outbreak at the Tyson facility on the Texas-Louisiana border. But Dr. Florencio Singson, who operates a clinic in Center, the county seat, told the Observer that health officials said the outbreak represents a “majority” of the county’s cases. Meanwhile, Tyson posted on its Facebook page that it is closing the facility this week. The post made no mention of the apparent outbreak, saying only that the company was installing new equipment at the plant.

Shelby County, population 25,400, has one of the highest per capita rates of confirmed COVID-19 cases in Texas. It’s nearly four times that of the state overall, and the highest countywide rate outside the Panhandle. Cases ballooned in Louisiana and into East Texas in recent weeks, with coronavirus now confirmed in nearly every Texas county in the region, many of which are rural and have limited medical resources. Many also have large populations of African Americans, who are being infected with and dying of coronavirus at disproportionately high rates.

Public health experts say the spread of coronavirus in the region (and the state overall, which had nearly 20,200 confirmed COVID-19 cases as of Tuesday evening) is likely dramatically undercounted due to limited testing. “We know it’s underreported [in Shelby County],” Singson told the Observer. Texas has been slow to roll out widespread testing, resulting in among the fewest completed tests per capita of any state.

As the Observer story notes, COVID-19 outbreaks have occurred at meat processing plants around the country, with the Smithfield outbreak in South Dakota being the worst so far. It’s not a surprise – workers are in close proximity, and there has been little done by their employers to keep them safe, which is typical for an industry that generally treats its employees terribly. Smithfield had the benefit of a union – you can listen to a short conversation with the local labor council president for Sioux Falls here if you want to learn more about that location – but it wasn’t enough. I can’t imagine the workers in Texas, at either location, having it any better. You want to know what’s in the future when and if we “reopen the economy” without a real plan and real resources for universal testing and worker protection, there you have it.

By the way, the city of Cactus, where the JBS plant is, is under an executive order requiring “everyone over the age of five” to “wear a covering over their mouth and nose when outside their home or vehicle”, with violators subject to a fine of up to $1,000. Sound familiar? Moore County voted 75% for Donald Trump in 2016. I’m just saying.

Treating COVID-19 patients at nursing homes

This is a huge can of worms.

When Larry Edrozo got a phone call from his mother’s nursing home in Texas City telling him she was being treated for the novel coronavirus with an unproven pharmaceutical drug, he had two questions: why was she getting the drug if she had not been showing symptoms, and who gave consent?

Helen Edrozo, 87, is one of 56 residents at the Resort at Texas City who tested positive for the coronavirus, and one of 39 residents being medicated with hydroxychloroquine, a drug typically used to treat malaria and lupus that has shown some evidence of possibly tamping down symptoms of the virus.

The use of hydroxychloroquine to treat coronavirus patients has drawn controversy globally as the medical community and public debate the ethics of testing a medication before significant research is available — and in the case of elderly patients such as those at The Resort at Texas City, on a population that is statistically more vulnerable to the virus. While President Donald Trump has touted the drug’s benefits, a large controlled study of hydroxychloroquine has not yet been completed, and some doctors warn the drug combination used for the experimental treatment could have severe, potentially deadly side effects.

Larry Edrozo was initially told by an administrator at the nursing home that Helen would not eligible for hydroxychloroquine treatment because she was not showing symptoms. But on Monday, a nurse at the facility phoned him to tell him that his mother’s carbon monoxide levels in her blood had elevated slightly and that she had already begun a hydroxychloroquine dose.

Edrozo was stunned. His mother has dementia, meaning that, as her power of attorney, he is supposed to sign off on any medical treatment she receives at the nursing home.

“I (told the nurse), ‘OK, well, since you’ve already started (treatment), I guess I would write in my notes that the question was raised about consent and what happened to that?’” Edrozo said. “I have not received a call back.”

Dr. Robin Armstrong, the medical director at The Resort, who prescribed the medication shortly after Amneal Pharmaceuticals donated 1 million tablets to the Texas Department of State Health Services pharmacy, said the decision was between him and his patients. He said he did not notify families before the drugs were administered because it was not necessary and time consuming.

“If I had to call all the families for every medicine that I started on a patient, I wouldn’t be treating any patients at all; I would just be talking to families all the time,” Armstrong said

But ethicists say informed consent is one of the most important factors in any treatment, and several people with family members at the Resort at Texas City being treated with hydroxychloroquine say that they were not asked to give consent, despite having power of attorney over their sick relatives.

Still, faced with the desperation of potentially losing his mother to the coronavirus, Edrozo felt he had no other choice than accept this course of treatment.

“When the people are blasting the doctors and the governor’s office about human guinea pigs, I’m sort of there with them,” Edrozo said. “But then I want to ask them, ‘What if it was your mother, or your spouse or your child?’”

As the kids say, there’s a lot to unpack here. At the most basic level, there’s nothing but anecdotal evidence that hydroxychloroquine has any effect on coronavirus. There are no studies worthy of the name showing that it would help. Maybe it will, maybe it won’t, we just don’t know. And that’s without taking into account the inability of these patients on whom the tratment is being tested to give informed consent for their participation. Or the fact that hydroxychloroquine is an actual drug used by people suffering from lupus and malaria, and Donald Trump’s obsession with it as an unproven treatment for COVID-19 means potential shortages for those patients. Did I mention that the doctor leading this effort is a Republican activist who got a supply of the drugs through political connections, and who therefore has a vested interest in making Trump and his hydroxychloroquine predictions look good? All this, and even if it does help some of these patients it won’t tell us anything about the effectiveness of hydroxychloroquine as a treatment because this isn’t a controlled study. Keep in mind, everyone who has recovered from COVID-19 has done so on their own. We’ll have no way of knowing whether the people at The Resort who recover would have done so anyway – that’s why doing controlled studies matter, so you can make valid comparisons. I very much get Larry Edrozo’s dilemma, but he and everyone else involved in this deserved to have full knowledge of the risks and benefits so they could make their own decision.

We still have no idea how many people have been infected

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

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

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

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

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

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

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

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

[…]

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

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

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

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

Texas officials defended the state’s response.

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

The information Texans are working with is too damn thin.

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

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

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

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

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

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

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

We don’t really know how many COVID-19 patients there are in Texas hospitals

For a variety of reasons, the data is hard to get a handle on.

Be like Hank, except inside

Texas is bracing for a pandemic that is projected to kill tens of thousands of people across the U.S., but health officials and state leaders are struggling to provide the public with timely updates on how many people are infected and how many hospital beds and ventilators are available for the critically ill.

Other states across the country have been providing coronavirus hospitalization figures for weeks. On Friday, Gov. Greg Abbott announced that 827 people have been hospitalized in Texas. But the true number of cases is likely far higher than the official tally due to a shortage of reliable tests and delays in delivering results, which can take up to 10 days.

Even with the limited number of confirmed positives, Harris County’s top epidemiologist says it feels like her team is constantly behind.

“It’s become overwhelming,” said Dr. Dana Beckham, director of the county’s Office of Science, Surveillance and Technology, which traces the steps of people who test positive for COVID-19 to determine how they got the disease and who they may have infected. “We’re always behind the eight ball.”

The county’s epidemiologists were pulling 12-to-16-hour days, seven days a week and they still couldn’t keep up, Beckham said. They brought in more workers – roping in other county government employees and hiring outside contractors – to prevent burnout and alleviate stress, tripling the number of people working in the unit to about 65.

It’s still not enough, she said.

As health officials scramble to mitigate the worst pandemic in generations, the level of detail released by Texas lags behind that of some counties and cities.

The Texas Department of State Health Services publishes a daily update of the official number of confirmed coronavirus cases — there were 5,330 statewide as of Saturday and 90 deaths. But the agency doesn’t routinely publish other key measurements that could show the potential for strain on Texas’ health care system in the coming weeks.

[…]

The 827 hospitalized coronavirus patients in Texas are confirmed COVID-19 cases — not suspected cases in which patients are exhibiting symptoms but have no test results, said Chris Van Deusen, a spokesman for DSHS.

Front-line health care workers in the Houston area have told the Houston Chronicle that many patients who should be tested and hospitalized are slipping through the cracks. They also worry that patients admitted with other conditions, such as a heart attack, who also are showing symptoms of the virus may not show up in overall counts.

Unconfirmed COVID-19 cases are likely taking up a significant number of hospital beds. According to the Southeast Texas Regional Advisory Committee, an organization tasked with tracking medical resources in Houston and the surrounding area, as of Thursday more than 700 patients with COVID-19 symptoms — which includes confirmed and suspected cases — had been hospitalized in Harris County alone.

More than 240 were being treated in intensive care units in the county, which has about 4.7 million residents. There were 480 patients on ventilators as of Thursday and 684 additional ventilators were available.

“Currently, we do not have any hospitals reporting that they are nearing capacity,” Darrell Pile, SETRAC’s chief executive officer, told the Chronicle in an email. “Available beds can actually rise if a hospital opens a closed wing, or opts to use beds in the recovery room or other specialty areas to care for inpatients.”

Van Deusen said the state health department had initially collected statistics on suspected cases from hospitals, but by Tuesday had only received reports on 629 patients statewide, raising questions about the accuracy of the state’s figures.

“Hospitalization reporting is a work in progress, and we’re definitely still refining the process,” Van Deusen said.

There’s too much to summarize, so I’d advise you to read that story and also this story about why the official reported numbers of COVID-19 cases in Texas is likely an order of magnitude too low. We’re not doing much testing, which means we can’t really track where the disease is trending, and we’re really just guessing about our hospital capacity and the potential for it to be overwhelmed. We can’t really tell if the local stay-at-home orders, which are now two weeks old, or the previous orders closing schools and canceling public events, which are coming up on four weeks’ duration, have had any effect on flattening the curve. The peak of the outbreak is likely still three or four weeks from now, so whatever the numbers are today, they are going to be a lot higher in the near future. That best-case IHME study Abbott is touting projects four to five thousand deaths in Texas; as of Sunday the official count was 127. That count is also likely low, for the same reasons – not everyone who needs it is getting tested, COVID-19 may be one of several causes of death but not the “official” one, etc – but the point is, we’re barely on the upswing of the curve. We have a lot of staying at home yet to do.

The state responds to coronavirus

Like it or not, we need to be prepared.

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

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

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

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

[…]

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

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

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

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

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

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