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Texas Department of State Health Services

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.

The extraordinary danger of being pregnant and uninsured in Texas

So utterly appalling.

Right there with them

From 2012 through 2015, at least 382 pregnant women and new mothers died in Texas from causes related to pregnancy and childbirth, according to the most recent data available from the Department of State Health Services; since then, hundreds more have likely perished. While their cases reflect the problems that contribute to maternal mortality across the United States — gross medical errors, deeply entrenched racism, structural deficiencies in how care is delivered — another Texas-size factor often plays a significant role: the state’s vast, and growing, problem with health insurance access.

About one in six Texans — just over 5 million people — had no health insurance last year. That’s almost a sixth of all uninsured Americans, more than the entire population of neighboring Louisiana. After trending lower for several years, the Texas rate has been rising again — to 17.7% in 2018, or about twice the national average.

The numbers for women are even worse. Texas has the highest rate of uninsured women of reproductive age in the country; a third were without health coverage in 2018, according to a DSHS survey. In some counties, mainly along the Mexico border, that estimate approaches 40%.

Public health experts have long warned that such gaps can have profound consequences for women’s health across their lifespans and are a critical factor in why the U.S. has the highest rate of maternal deaths in the developed world. Texas’ maternal mortality numbers have been notably troubling, even as errors in key data have complicated efforts to understand what’s going on and led skeptics, including the governorto question whether there’s really a crisis.

Hardly anyone outside the policy world has taken a deep look at how these insurance gaps play out for women in the second-largest state in the U.S. — at how, in the worst-case scenarios, lack of access to medical care endangers the lives of pregnant women, new mothers and babies.

ProPublica and Vox have spent the last eight months doing just that — combing through government data and reports, medical records and research studies, and talking with scores of women, health care providers, policymakers and families of lost mothers around the state. We learned about Rosa Diaz and dozens of others, mostly women of color, by scouring medical examiner’s databases for sudden, “natural” deaths, then inspecting investigator and autopsy reports for clues about what went wrong.

The picture that emerges is of a system of staggering complexity, riddled with obstacles and cracks, that prioritizes babies over mothers, thwarts women at every turn, frustrates doctors and midwives, and incentivizes substandard care. It’s “the extreme example of a fragmented system that cares about women much more in the context of delivering a healthy baby than the mother’s health in and of itself,” said Eugene Declercq, professor of community health sciences at Boston University School of Public Health.

Most of the mothers whose cases we examined were covered by Medicaid for low-income pregnant women, a state-federal health insurance program that pays for 53% of the births in Texas, more than 200,000 a year, and 43% of all births nationwide. In Texas, the program covers OB-GYN visits, medications, testing and nonobstetric care, from endocrinologists to eye exams.

But the application process is so cumbersome that women in the state have the latest entry to prenatal care in the country, ProPublica and Vox found. It can take months to be seen by regular providers and even longer to access specialists. This poses the greatest danger for high-risk mothers-to-be — as many women on Medicaid are, having had no medical care for significant parts of their lives. Then, roughly two months after delivery, pregnancy Medicaid comes to an end, and the safety net gives way to a cliff. For many new mothers, the result is a medical, emotional and financial disaster.

More than half of all maternal deaths in the U.S. now occur following delivery, according to the Centers for Disease Control and Prevention, with as many as 24% happening six or more weeks after a woman gives birth. In Texas, the proportion of late-postpartum deaths is closer to 40%, with black women bearing the greatest risk. “To lose health care coverage really has a tremendous potential to worsen outcomes,” said Dr. Lisa Hollier, chief medical officer for obstetrics and gynecology for Texas Children’s Health Plan and chair of the state’s maternal mortality review committee.

This is a long excerpt, but there’s a lot more to the story, so please read the whole thing. There are numerous policy decisions at fault here – not expanding Medicaid, low Medicaid reimbursements, cutting off Planned Parenthood and substituting in wholly inadequate alternatives, and more – and all of them can be laid at the feet of the state’s Republican leadership. Whoever runs against Greg Abbott and Dan Patrick and Ken Paxton in 2022 should loudly and repeatedly assert that every maternal death in Texas is their fault. I keep saying this, and it keeps being true: Nothing will change until we have different, and better, government in this state. There’s no other way to do it.

“I’m haunted by their eyes”

We should all be haunted, and outraged, by this.

Immigrants held in a McAllen-area U.S. Customs and Border Patrol processing center for migrants — the largest such center in America — are living in overcrowded spaces and sometimes are forced to sleep outside a building where the water “tastes like bleach,” according to an attorney who recently interviewed some of the migrants.

“It was so bad that the mothers would save any bottled water they could get and use that to mix the baby formula,” attorney Toby Gialluca told The Texas Tribune on Saturday.

But when she recalls the conditions described to her by the immigrants she interviewed at McAllen’s Centralized Processing Center, Gialluca said she goes back to one thing.

“Their eyes. I’m haunted by their eyes,” Gialluca said.

Gialluca and a slew of other lawyers have been meeting with children and young mothers at facilities across the state this month as pro bono attorneys. At the McAllen Center, Gialluca said everyone she spoke with said they sought out Border Patrol agents after crossing the Rio Grande so they could request asylum.

Gialluca said the migrants, all from Honduras, Guatemala, and El Salvador, told her they aren’t receiving proper medical care and children don’t have enough clean clothes. Unable to clean themselves, young mothers reported wiping their children’s runny noses or vomit with their own clothing, Gialluca said. There aren’t sufficient cups or baby bottles, so many are reused or shared.

“Basic hygiene just doesn’t exist there,” Gialluca said. “It’s a health crisis … a manufactured health crisis,” she said.

[…]

On Saturday, state Sen. Carol Alvarado, D-Houston, issued a letter to the Texas Health and Human Services Commission inquiring about the reportedly inhumane conditions at a Clint facility where another group of lawyers told the Associated Press about a group of 250 infants, children and teens who spent nearly a month without adequate food, water and sanitation.

Attorneys who visited the El Paso-area station said they found at least 15 children sick with the flu and described a sick and diaperless 2-year-old boy, whose “shirt was smeared in mucus,” being taken care of by three girls all under 15.

“HHSC has a responsibility to these children and individuals to ensure they are receiving, at a minimum, basic care,” Alvarado wrote, acknowledging that the facilities are managed at a federal level, but still imploring the state to do more. “As these facilities are in our state, the conditions under which they operate is a reflection of our values and commitment to the humane treatment of all within our borders.”

There are a lot of elected officials in this state who support passing laws greatly restricting access to abortion because they say they believe in the sanctity of life. Most of those same officials oppose laws that grant equal treatment under the law to LGBTQ people, and support laws that allow “sincerely held religious beliefs” to be a legal reason to not do business with LGBTQ people, because they believe that LGBTQ people are engaged in immoral behavior. These same elected officials, who care so much about life and morality, don’t have so much as an unkind word to say about the appalling, inhumane treatment of thousands of people, many of them children and babies, right here in Texas. I don’t know why any moral authority is granted to these officials, whose names include Greg Abbott, Dan Patrick, Ken Paxton, John Cornyn, Ted Cruz, Chip Roy, Dan Crenshaw, Ron Wright, Lois “Bathroom Bill” Kolkhorst, Jonathan “Former Fetus” Stickland, Tony “Death Penalty For Abortion” Tinderholt, and many many more. They have clearly shown that they don’t deserve it.

UPDATE: In addition to voting all of these useless assholes out of office, you can donate to or volunteer for any of these organizations if you want to help do something about this.

Our vaccine exception rates keep going up

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

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

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

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

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

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

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

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

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

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

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

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

Pickle ’em if you got ’em

A victory for home foodies.

Sen. Lois Kolkhorst

In a victory for home cooks across Texas, the Legislature has expanded the state’s definition of the word “pickle,” allowing for pickled beets, carrots and other produce to be easily sold at farmers’ markets alongside pickled cucumbers.

The legislation, pushed by state Sen. Lois Kolkhorst, R-Brenham, and state Rep. Eddie Rodriguez, was passed by the House Tuesday and given final approval by the Senate Thursday. It still needs a signature from Republican Gov. Greg Abbott before becoming law.

Judith McGeary, head of the Farm and Ranch Freedom Alliance, said her group is excited to see the measure advance and that it would broaden “options for the farmers and the consumers who are looking for healthy, locally-made foods.” Texas has been among the more restrictive states in allowing foods to be sold at markets, she said.

Texans have been able to hawk pickled cucumbers in local venues since 2013, when Rodriguez, an Austin Democrat, authored a law that let cooks sell certain goods without first becoming licensed food manufacturers. But an unexpected rule authored by the state’s Department of State Health Services has barred home chefs from selling any other kind of pickled produce without first installing a commercial kitchen, taking a course, and obtaining a special license.

“Only pickled cucumbers are allowed,” an FAQ section on the agency’s website specifies. “All other pickled vegetables are prohibited.”

The rule was drafted to implement the new law, and a department spokesperson told the Texas Tribune last May that the agency did not receive objections to the pickle definition. The spokesperson declined to comment Tuesday.

[…]

Laws authored by Kolkhorst and Rodriguez had already made it easier for home cooks to peddle their goods at local markets, by exempting them from regulations that some consider onerous. An old rule that small-batch bakers have a commercial kitchen, for example, was jettisoned in 2011. The exemption was extended to a host of other foods in 2013, including fruit butters, popcorn and pickles — though the State Health Services department took that to mean pickled cucumbers only.

As the story notes, a couple who intended to make some money pickling vegetables filed a lawsuit against State Health Services, which brought the issue to light. The story also notes the cottage food law, which passed in 2011 in its second attempt. I am as before on the side of the home foodies, so I’m glad to see this bill get passed. Hopefully, there will be no more weird bureaucratic interpretations necessitating further bills like this one.

What’s going on in Skull Creek?

Here’s a story from a couple of weeks ago that you may have missed. I know I missed it until it was pointed out to me.

For more than two months, the waters of Skull Creek have flowed black, its surface covered in an iridescent sheen. Yellowed fish skeletons line the pebbled banks of the Colorado River tributary, and a dizzying chemical odor hangs in the air.

The odor is so strong that Julie Schmidt says she can smell it inside her house.

She and her husband bought 10 acres along the creek in December with visions of an idyllic country upbringing for their children, ages 10 and 2. Now, she isn’t sure they should play outside.

“Last summer, you could go into the creek behind the house and it was crystal clear. You could play in it, you could fish,” said Schmidt, who moved from nearby Garwood and has lived in Colorado County her entire life. “Now you don’t want to touch it. You pick up a rock, turn it upside down, and it’s completely black.”

Locals and elected officials in this small southeast Texas community near the intersection of Interstate 10 and Texas 71 say the source of the problem is obvious: an oil and gas waste recycling facility near the creek that is owned by Columbus-based Inland Environmental and Remediation. Although Inland has denied wrongdoing, the Texas attorney general sued the company Friday — 10 weeks after citizens first began complaining — alleging the company illegally discharged industrial waste into the creek and stored that waste without a permit.

On Friday, a state district court in Travis County granted a temporary restraining order against the company and its president, David Polston, saying he must “cease and prevent all discharges of waste” from the site into state waters.

The state’s lawsuit seeks monetary damages of up to $1 million.

The Texas Railroad Commission ordered the facility to stop storing oil and gas waste in 2017 as a result of a bankruptcy court reorganization. (The permit was held by Boundary Ventures, a company at the same location that lists Polston as its president and director.)

Records obtained by The Texas Tribune show that the Texas Commission on Environmental Quality dispatched inspectors to the facility Feb. 10 — the same day that Colorado County Judge Ty Prause says he made a formal complaint — and hand delivered a letter two days later demanding that Polston take immediate action to halt the discharge of waste into the creek. The letter described conditions at the facility as an “imminent threat and substantial endangerment to human health and/or the environment.”

But Prause, the county’s chief executive, said the agency left him and other officials in the dark for weeks about the origins of the pungent substance and what guidance he should give to his constituents to protect themselves.

“It’s hard to imagine that the state agencies in charge of protecting our environment and natural resources in Texas would not act quicker to tell people that live on this creek whether there’s a threat to their health or their livestock,” said Prause, who oversees emergency response for the county.

I encourage you to read the rest. Most of the coverage of this story has come from the Colorado County Citizen, with reporting by my friend and former blogging colleague Vince Leibowitz, who was the one to alert me to all this. Their first story, about the appearance of the black water and dead fish, is here, datelined February 15. The litigation referred to in the Trib story is ongoing, and I hope it will help uncover the truth about what happened, and hold the parties responsible for it to account. As Leibowitz wrote in an editorial, the “alphabet soup” of state agencies that have authority here have not been doing a good job, with the exception for the most part of the Railroad Commission. I don’t know what it’s going to take to figure out and clean up a big toxic waste spill like this, but we sure need to get on it.

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

There’s only one solution to the anti-vax crisis

They have to be beaten at the ballot box. There’s no other way.

On the South steps of the Texas Capitol, state Rep. Briscoe Cain prayed that the children standing beside him would not be mocked for their parents’ decision not to vaccinate them.

“We ask that you strengthen these children … we ask that you shield them,” said Cain, R-Deer Park. “May government leaders never forget that parents know what is best for their children.”

On Thursday, more than 300 anti-vaccination advocates and their children rallied with Texans for Vaccine Choice to support bills filed by a handful of state lawmakers that would require doctors to provide families with both the “benefits and risks of immunization,” and make it easier to opt out.

“I walk these halls and I see … the fun they are poking at our children and our families, and it angers me,” said the group’s president, Jackie Schlegel, who said her daughter is disabled due to complications from a vaccine. “The time is now to stand up, to be here for your families, to be here for your children, the ones who do not have a voice.”

Statewide data shows a steady rise in children whose parents have claimed conscientious exemptions from vaccine requirements. In 2018, 76,665 individuals requested affidavits for the exemption, an 18.8-percent increase over 2017, and a 63.8-percent increase since 2014, according to the Texas Department of State Health Services.

As the movement grows, Texas has seen a series of outbreaks of infectious diseases that were thought to have been virtually eliminated in the U.S.

You can see what we’re up against. Measles are back, someone was walking around the Capitol with whooping cough, idiots are deliberately exposing their own children to chicken pox, it goes on and on. Reason, civic duty, compassion for the immunocompromised, nothing moves these people. The one thing we can do is throw the legislators who coddle them out of office. Diminish their power, and the rest takes care of itself. So, just as a reminder:

Jonathan Stickland, HD92, won in 2018 by a 49.8% to 47.4% margin, in a district where Beto O’Rourke got 48.3% of the vote.

Matt Krause, HD93, won in 2018 by a 53.9% to 46.1% margin, in a district where Beto O’Rourke got 48.2% of the vote.

Bill Zedler, HD96, won in 2018 by a 50.8% to 47.2% margin, in a district where Beto O’Rourke got 49.5% of the vote.

I wish I could make a case for Briscoe Cain’s vulnerability, but alas, he’s in one of the two most Republican districts in Harris County. Still, take those three out and you’ve really weakened the anti-vax core. You want to see fewer kids get easily preventable diseases in Texas? There’s your starting point.

The anti-vaxxers keep on coming

Eternal vigilance, and some more problematic legislators getting booted out of office, are required.

Among the new Texas proposals is an “informed consent” bill filed by state Representative Bill Zedler, an outspoken anti-vaccine member of the House Public Health Committee. Zedler drew national attention after he downplayed the resurgence of measles, which he had as a child, telling the Observer last month, “Today, with antibiotics and that kind of stuff, they’re not dying [of measles] in America.” (Hundreds of Americans died of measles each year before the disease was considered eradicated in 2000, thanks in large part to the development of a vaccine. Also, antibiotics don’t treat measles, which is a virus.)

[…]

bill filed by state Senator Bob Hall, R-Edgewood, would ban vaccines that haven’t met criteria that Hall — a retired business owner — has determined the U.S. Food and Drug Administration should be using for approval. The bill also requires the state health department to post online a “disclosure of any known injuries or diseases caused by the vaccine” and that the vaccine be “evaluated for [its] potential to: cause cancer, mutate genes, affect fertility or cause infertility, and cause autism spectrum disorder.”< The bill is “dangerous” and a “misunderstanding of how science and clinical trials work,” Lakshmanan said. Any link to autism, first proposed in a now-retracted study, has been repeatedly debunked. “The insinuation of this legislation is that vaccines are not well-tested and not safe, which is erroneous, incorrect and misleading,” she said. Hall did not respond to a request for comment.

Also of top concern for immunization advocates are proposals to make it even easier to opt out of vaccine requirements, even as “conscience” exemptions have skyrocketed in Texas from about 2,300 in 2003 to nearly 53,000 in 2017. A bill filed by House Freedom Caucus member Jonathan Stickland, R-Bedford, would allow nurses to sign off on exemption forms rather than just doctors. Another, from state Representative Tony Tinderholt, would prohibit doctors from refusing to see patients who aren’t vaccinated. And one from caucus member Matt Krause would make it easier to submit vaccine exemptions, and prevent the state health department from tracking them. Health experts say this would prevent the state from preparing for potential disease outbreaks, as well as make it impossible for families of very young or immunocompromised kids to know which communities have low vaccination rates.

See here for some background. You can find all these bills and more by going to the Texas Legislature Online page and doing a word/phrase search for “immunization”. It’s not always easy to tell with the language in these bills, but SB1813 by Sen. Jose Rodriguez, which appears to loosen requirements for pharmacists to administer vaccinations, looks good. I don’t see anything positive relating to the so-called “conscience clause” exemption, which is what allows parents to enroll unvaxxed kids in school because they don’t want to get them immunized. I don’t think we’re there yet for something like this. The best we can do this session is most likely going to be not letting anything bad get passed. Then we need to follow it up by beating as many of these anti-vax schmoes at the ballot box as we can. Make note of those names, these are the targets of interest.

It’s hard being pregnant in Harris County

We need to figure this out.

Life-threatening, pregnancy-related complications — the iceberg beneath the surface of the U.S. maternal health crisis — are on the rise in Harris County, according to a new report.

The report not only confirmed the Harris County rate is worse than that of the state and nation, it found that it increased more than 50 percent between 2008 and 2015. Texas’ rate of life-threatening, pregnancy-related complications went up 15 percent in the same time period.

“In subtle and unintentional ways, women’s health in Harris County has been subjugated to the health of babies so profoundly that the health of women of childbearing age is often not prioritized,” says the report, a project of the Houston Endowment.

Dr. Lisa Hollier, a Houston obstetrician-gynecologist and a co-chair of the task force that produced the report, said Harris County’s high rates “point to the need for greater intervention to promote safety around the time of delivery. Such complications are 50 times more common than pregnancy-related deaths, but don’t get near the amount of attention.”

Hollier and Dr. Cecilia Cazaban, the report’s principal investigator, said it is unclear why Harris County’s rate is increasing at such a high rate. They said that analysis is next on tap for the task force.

[…]

The new report focuses on severe maternal morbidity, the term for conditions that require such treatment as a respirator or blood transfusions or hysterectomy during delivery or in the immediate hours thereafter. It can lead to maternal death, but even when the patient survives, it can cause damage, such as kidney or heart failure, sometimes requiring lifelong treatment. It also is costly to the patient and health care system.

Harris County’s rate of severe maternal morbidity in 2015 was 2.4 percent, meaning there were 238 cases for every 10,000 deliveries. The 2015 rate was 1.97 in Texas and 1.46 in the United States.

See here for some background. The task force website is here, though I don’t think this report is on there. I hope there’s no need for me to say anything more than we really need to understand this problem so we can solve it.

Abbott waives fees for birth certificates for individuals from hurricane-affected counties

From Diane Trautman on Facebook, also sent to me in email:

Governor Greg Abbott has approved a request allowing the state to waive fees for mail-in or walk-in birth certificate issuance requests, and local registrars to waive fees for walk-in birth certificate issuance requests, for individuals from hurricane-affected counties. This is important for several reasons, one of which is that a birth certificate is a valid form of supporting documentation for voters without proper ID who need to sign an Affidavit of Reasonable Impediment.

A list of the affected counties is at the announcement. The language used is pretty legalistic, so unless you are familiar with “Section 418.016 of the code”, you may not realize from the announcement just what this means, so thanks to Diane Trautman for the interpretation. You probably know someone, or know someone who knows someone, who needs to know this, so please pass it on.

And then there’s the birth certificate issue

Just another problem that would be exacerbated by a bathroom bill.

In order to modify a birth certificate in Texas, the Department of State Health Services requires transgender individuals to present a certified court order stating the recorded sex on a birth certificate should be changed.

But a transgender person’s ability to obtain that court order is largely determined by where they live and their socioeconomic status, according to transgender individuals, advocates and lawyers who have worked with transgender Texans on the process.

Some county judges — even in more liberal urban areas — are less eager than others to grant the court order that’s required by the state, particularly when it comes to children. That forces some transgender individuals to travel to counties like Travis, Bexar or Dallas, where such court orders can be easier to obtain.

It can also be an expensive process. Court filings fees can reach $300 even before adding on attorneys fees or travel requirements. The process can be even more cost-prohibitive for transgender individuals because they must also obtain letters from both a doctor and a mental health provider certifying they are transgender and under their care to present to the court. For some, that also presents a geographic barrier because Texas faces a shortage of doctors and therapists “who do this kind of work,” said Claire Bow, an Austin-area attorney who helps transgender people obtain updated documents.

But for Bow, there’s a bigger flaw with Republicans’ proposals for bathroom restrictions and the expectation that transgender people could immediately take steps to obtain updated documents.

“The important thing to understand is it’s never the first step in the process,” Bow said of amending birth certificates or IDs. Bathroom bills assume that every transgender person has “gone all the way through the process” or have reached the point in treatment at which their doctors and therapists will sign off on the letter needed for court.

“That’s why this is hard,” she added. “Nobody wakes up one day…and changes their sex.”

The outcome of this complex process is that many transgender Texans live with birth certificates that don’t align with their gender identity for years if not their entire lives.

This is not the first time this issue has been brought up. Getting one’s birth certificate amended can be expensive and time-consuming, and if you happen to have been born in the wrong state, legally impossible. One way Republicans could address this issue would be to make it less cumbersome to amend a birth certificate, with some provision for the folks whose home states have no such mechanism. Of course, if they were inclined to do that, it might lead them to the conclusion that the bathroom bill is ridiculous and harmful and serves no purpose.

This session’s unconstitutional abortion bill passes

Here we go again.

Right there with them

Texas senators voted Friday to send a bill banning the most common second-trimester abortion procedure and changing how health care facilities handle fetal remains to Gov. Greg Abbott’s desk.

Under Senate Bill 8, which passed 22-9, health care facilities including hospitals and abortion clinics would be required to bury or cremate any fetal remains — whether from abortion, miscarriage or stillbirth. The bill would also ban facilities from donating aborted fetal tissue to medical researchers, and aims to outlaw “partial-birth abortions,” which are already illegal under federal law.

Most controversially, the bill now bans dilation and evacuation abortions — a common second-trimester procedure where doctors use surgical instruments to grasp and remove pieces of fetal tissue — unless the fetus is deceased. Medical professionals deem the current method the safest way to perform the procedure on a pregnant woman, and reproductive rights groups have said this change would subject women to an unnecessary medical procedure.

[…]

Amanda Allen, senior state legislative counsel for the Center for Reproductive Rights, said in a news release that Texas legislators are continuing “their crusade against a woman’s right to safe and legal abortion.”

“Texas women deserve access to the health care that is best for them and their personal circumstances — not abortion restrictions pushed by extreme anti-abortion organizations,” Allen said. “The Center for Reproductive Rights vows to battle any unconstitutional measures in the courts until the rights of Texas women are respected and protected.”

The group sued late last year over a Texas Department of State Health Services proposal requiring health providers to bury or cremate fetal remains. Center lawyers won a temporary restraining order and in January a federal judge ruled Texas could not proceed with the rule, citing its vagueness and potential to harm patients.

See here for the background. I don’t know what to say that I haven’t said already, but if I’m going to repeat myself anyway, I’ll say this again: Nothing will change until the people we elect change. We have a chance to do something about this next year. It’s up to us.